P 45 Ultrasonography of facial muscles in patients with Parkinson’s disease

Abstract

Purpose Parkinson’s disease is one of the commonest movement disorders, characterized by bradykinesia, rigor or tremor. While a standardized protocol for sonography of the mimic musculature is already applied in patients with facial palsy, it was not known, whether the protocol can also be used for objective analysis of facial muscles in patients with Parkinson’s disease. Material & methods Using a eZono4000, eZono, Germany, with linear probe (L3-12), bilateral scans of seven facial muscles and two masticatory muscles were performed in 38 patients with Parkinson’s disease (18 women; Hoehn & Yahr 1–5; mean/SD: 3.01/1.07; mean UPDRS III 32.47/14.78). The scans were based on the same standardized examination protocol ( Volk, 2014 ). Following muscles were scanned at rest and at maximal contraction: frontalis, orbicularis oculi, zygomaticus major, orbicularis oris, depressor anguli oris, depressor labii inferioris, mentalis, and masseter and temporalis muscle. The muscles cross-sectional areas as well as the biggest longitudinal- and cross-diameter at rest and maximal contraction were manually segmented. The results were compared with reference values of healthy subjects and correlated with the clinical data describing the severity of the Parkinson’s disease (UPDRS III; single items: finger tapping/facial expression). Results In patients with Parkinson’s disease nearly every acquired muscle cross-section and also the ability to contract were significantly ( p r = −0,296/ p = 0,080) and to the item facial expression ( r = −0.345/ p = 0.034). Due to the explorative character of the study, methods to counteract the problem of multiple comparisons were not applied. Conclusion The ultrasonography can be applied to describe changes in facial muscles characteristic for Parkinson’s disease. Especially the impact of the bradykinesia expressed as the reduced ability to contract can be objectively assessed. After this proof-of principle investigation further longitudinal studies in larger cohorts are necessary to evaluate the dependence between clinical features and ultrasonography.