Electrical Stimulation

The use of electrical stimulation is not generally advised in facial palsy management. This includes all types of electrical stimulation such as external muscle or nerve stimulation, and electro-acupuncture.

Research has shown that electrical stimulation gives the least effective results when compared with all the available therapeutic treatment options1,2. It has also shown that electrical stimulation can actually reduce muscle innervation during recovery as well as making users more likely to go on to develop synkinesis3,4.

In synkinetic patients it activates already overactive muscles and further reinforces abnormal movement patterns resulting in worse outcomes5,6. The underlying premise for using electrical stimulation in patients with synkinesis is erroneous. Once it is understood that the lack of movement is due to abnormal muscle synchronisation as opposed to muscle weakness there is simply no need to stimulate the facial muscles5.

There is one group of patients who may benefit from electrical stimulation and who are not at risk of developing muscle tightness or synkinesis. These patients have complete loss of their facial nerve which may have been cut or irrevocably damaged by disease. In some cases the person may have been born without a facial nerve. The presence of the nerve is not required for external electrical stimulation to be used. It is the muscles which are stimulated not the nerve. The benefits are short lived so that once you stop using the electrical stimulation the muscle will lose its tone. This treatment should only be given under strict guidance from a specially trained therapist.

References

1 Ryzenman JM, Pensak ML, Tew JM Jr. Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery. Otol Neurotol. 2005;26(3):516-521.

2 Skouras E, Merkel D, Grosheva M, et al. Manual stimulation, but not acute electrical stimulation prior to reconstructive surgery, improves functional recovery after facial nerve injury in rats. Restor Neurol Neurosci. 2009;27(3):237-251.

3 Sinis N, Horn F, Genchev B, et al. Electrical stimulation of paralyzed vibrissal muscles reduces endplate reinnervation and does not promote motor recovery after facial nerve repair in rats. Ann Anat. 2009;191(4):356-370.

4 Fargher KA, Coulson SE. Effectiveness of electrical stimulation for rehabilitation of facial nerve paralysis. Phys Ther Rev 2017;22:169–176.

5 Diels HJ. Facial paralysis: is there a role for a therapist?. Facial Plast Surg. 2000;16(4):361-364.

6 Salles AG, da Costa EF, Ferreira MC, do Nascimento Remigio AF, Moraes LB, Gemperli R. Epidemiologic Overview of Synkinesis in 353 Patients with Longstanding Facial Paralysis under Treatment with Botulinum Toxin for 11 Years. Plast Reconstr Surg. 2015;136(6):1289-1298.

Last reviewed: 01-03-2022    ||    Next review due: 30-04-2024