title: Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis.
abstract: Recently it has been proposed that corticobulbar innervation of the lower facial muscles is bilateral, that is from both right and left sides of the motor cortex. The objectives of this study were, i) to evaluate the corticonuclear descending fibers to the perioral muscles and, ii) to determine how central facial palsy (CFP) occurs and often recovers rapidly following a stroke. Eighteen healthy volunteers and 28 patients with a previous history of a stroke and CFP (mean ages: 51 and 61 years) were investigated by TMS (transcranial magnetic stimulation) with a figure of eight coil. Intracranial facial nerve and cortical motor evoked potentials (MEPs) were recorded from the perioral muscles. The periorbital MEPs were also studied. The absence of MEPs in both perioral muscles with TMS of the affected hemisphere was the most obvious abnormality. Also, central conduction time was significantly prolonged in the remaining patients. The mean amplitude of the affected hemisphere MEPs was diminished. The amplitudes of the unaffected hemisphere MEPs recorded from the intact side were enhanced especially in the first week following the stroke. During TMS, only the blink reflexes were elicited from the periorbital muscles due to stimulus spreading to trigeminal afferent nerve fibers. It is concluded that perioral muscles are innervated by the corticobulbar tract bilaterally. CFP caused by a stroke is generally incomplete and mild because of the ipsilateral cortical and multiple innervations out of the infarction area, and recovers fast through cortical reorganisation.
authors.affiliation: Abant Izzet Baysal University, Medical School Hospital Dept. of Neurology Gölköy, Bolu, Turkey (Türkiye). nebily@hotmail.com
authors.forename: Nebil
authors.initials: N
authors.lastname: Yildiz
authors.forename: Cumhur
authors.initials: C
authors.lastname: Ertekin
authors.forename: Tolga
authors.initials: T
authors.lastname: Ozdemirkiran
authors.forename: Serpil Kuyucu
authors.initials: SK
authors.lastname: Yildiz
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aydogdu
authors.forename: Burhanettin
authors.initials: B
authors.lastname: Uludag
authors.forename: Yaprak
authors.initials: Y
authors.lastname: Secil
mesh_terms: D000328:Adult; D000368:Aged; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology / Q000528:radiation effects; D005152:Facial Muscles / Q000503:physiopathology*; D005158:Facial Paralysis / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology / Q000528:radiation effects; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D013997:Time Factors
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