title: A neurophysiological study of facial numbness in multiple sclerosis: Integration with clinical data and imaging findings.
abstract: OBJECTIVE
  To integrate neurophysiological findings with clinical and imaging data in a consecutive series of multiple sclerosis (MS) patients developing facial numbness during the course of an MS attack.
  
  
  METHODS
  Nine consecutive patients with MS and recent-onset facial numbness were studied clinically, imaged with routine MRI, and assessed neurophysiologically with trigeminal somatosensory evoked potential (TSEP), blink reflex (BR), masseter reflex (MR), facial nerve conduction, facial muscle and masseter EMG studies.
  
  
  RESULTS
  All patients had unilateral facial hypoesthesia on examination and lesions in the ipsilateral pontine tegmentum on MRI. All patients had abnormal TSEPs upon stimulation of the affected side, excepting one that was tested following remission of numbness. BR was the second most sensitive neurophysiological method with 6/9 examinations exhibiting an abnormal R1 component. The MR was abnormal in 3/6 patients, always on the affected side. Facial conduction and EMG studies were normal in all patients but one.
  
  
  CONCLUSIONS
  Facial numbness was always related to abnormal TSEPs. A concomitant R1 abnormality on BR allowed localization of the responsible pontine lesion, which closely corresponded with MRI findings. We conclude that neurophysiological assessment of MS patients with facial numbness is a sensitive tool, which complements MRI, and can improve lesion localization.
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: gkoutsi2@otenet.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Koutsis
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kokotis
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Aikaterini E
authors.initials: AE
authors.lastname: Papagianni
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria-Eleftheria
authors.initials: ME
authors.lastname: Evangelopoulos
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Kilidireas
authors.affiliation: 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karandreas
mesh_terms: D000328:Adult; D001767:Blinking; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory; D005145:Face / Q000503:physiopathology; D005152:Facial Muscles / Q000503:physiopathology; D005154:Facial Nerve / Q000503:physiopathology; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008406:Masseter Muscle / Q000503:physiopathology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009431:Neural Conduction; D065821:Pontine Tegmentum / Q000000981:diagnostic imaging*; D012018:Reflex; D014276:Trigeminal Nerve / Q000503:physiopathology; D055815:Young Adult
keywords: Blink reflex; Facial numbness; MS; Multiple sclerosis; Trigeminal nerve; Trigeminal somatosensory evoked potentials