[Strategy for the prevention and treatment of post-paralytic facial syncinesis]

The existence of facial heimspasm and post-paralytic syncinesia is in general interpreted as the result of aberrant reinnervation following a Bell's palsy. In a certain number of cases, electrophysiological tests reveal synaptic abnormalities in the facial nucleus. These findings must be taken into consideration, together with the possibility of ephapsic stimulation of the proximal part of the facial nerve, when explaining the regression of syncinesia which is found in certain patients during the reinnervation phase. Prevension is based principally upon the quality of treatment and the rapidity with which both electrophysiological testing is undertaken and treatment started. It is important to avoid treatment aimed at accelerating reinnervation (neuronotrophic factors, dielectrolysis, etc . . . The process should take place naturally. Electrical stimulation, administered under conditions of choice of current on the basis of the lesion, experimentally prevents dissemination of reinnervation. Repeated evaluation of possible diffusion of the blink reflex can be used to detect sub-clinical stages of progression to syncinesia. It would seem necessary to review from a particular standpoint the organised programming of physiotherapy and its association with biofeedback-EMG techniques. If signs of syncinesia develop, appropriate physiotherapy, biofeedback-EMG techniques and contralateral strio-motor electrotherapy combined with sedative and anti-paroxysmal therapy should be started.