Facial Neuropathy Research Articles

BS06. Characteristic electromyographic pattern in complete congenital facial paralysis

The facial paralysis is the most frequent paediatric cranial nerve mononeuropathy, being the idiopathic facial nerve neuropathy the most frequent acquired cause. During the neonatal period the obstetric traumatic injury is the most frequent and rarely we can recognise a congenital facial paralysis without trauma. Sometimes the dysfunction of cranial nerve VII is manifested by unilateral, partial or complete paralysis of the facial musculature. In new- born babies the facial EMG and nerve conductions studies provides key information to elucidate the degree of facial defects and the also to determine pathogenesis of the facial weakness. This is a retrospective study where we review patients with pure unilateral congenital facial paralysis diagnosed during the neonatal period without trauma, excluding the Mobius syndrome defined as bilateral congenital facial paralysis associated with other abnormalities. We review clinical reports and the electromyographic tests: All patients have facial nerve neurographic examinations, EMG with concentric needle tests, and some of them blink reflex to evaluate the degree of facial involvement. We differentiate a group of patients with a characteristic pattern where mainly the facial nerve lesion seems complete, but the EMG examination and clinical examination is not concordant: Clinically they have a sever facial asymmetry, but preserve orbicularis oris contraction, and some degree of eye closure. CMAP at the orbicularis oris was absent in all patients, but they have a normal electromyographic pattern at the orbicularis oris supplied by the contralateral healthy facial nerve. Congenital facial paralysis is a rare entity that frequently involves partially facial nerve, but in some cases the facial nerve lesion are complete and have a peculiar clinical and neurophysiological behaviour. In complete congenital facial paralysis the Orbicularis oris function is preserved, and the innervation comes from the contralateral facial nerve not damaged. Some degree of eye closure is also preserved but without no contraction of the orbicularis oculi. A correct EMG examination can determine the pattern of involvement, can early help or suggest the clinician the MRI indication to understand the nature of the facial nerve lesion and can help to plan adequate facial surgical treatment if it is considered.

Full Recovery of the Patient With Bell’s Palsy Within Two to Six Weeks After Single Course of Pulsed Electromagnetic Therapy-Case Reports

Bell’s palsy (BP) is the one of the most common causes of facial nerve neuropathy cause facial paralysis. Etiology of the BP is not known. Diagnosis made according to anamnestic data and clinical examination. Other pathology as CVA, Lyme disease, viral infection, brain tumors must be excluded. A degree of nerve damage graduate according to modified House-Brackmann score. Corticosteroids, antiviral therapy, symptomatic treatment, physiotherapy, alternative medicine and surgical intervention, in some severe cases with residual palsy, are the treatments of choice. About 70% of patients had a full recovery and in some cases without any treatment. However, 30% had residual damage to the facial nerve, and functional disability and 12% have a recurrence. In the article, authors present new treatment modality known as Pulsed Signal Therapy (PST®) that was applied as management for severe pain around the ear of the affected side and surprisingly cased for full recovery of two patients with BP between two to six weeks after treatment.

Fractionated Stereotactic Radiation Therapy for Large Vestibular Schwannomas

Fractionated stereotactic radiotherapy (FSRT) is a well-established and effective treatment for vestibular schwannomas (VS). For larger VSs with brainstem compression, debulking surgery is often performed prior to radiation to reduce treatment volume and to decrease potential radiation damage to the brainstem and cranial nerves V and VII. The goal of this study was to retrospectively evaluate the clinical outcomes of patients with large VSs treated with FSRT at our institution. 60 patients were identified who had VSs treated with FSRT between 2009 and 2016. All patients were treated on a Novalis TX linear accelerator platform with a dose of 25 Gy in 5 fractions. Patients were categorized by Koos stage into small VS group (Koos stage 1 or 2) and large VS group (Koos stage 3 or 4). Outcomes of tumor control (freedom from radiographic progression), degree of trigeminal nerve dysfunction, degree of facial nerve dysfunction (using the House-Brackmann scale), and brainstem toxicity (radiographic necrosis) were assessed prior to treatment and at the most recent follow-up. The dose of radiation to the VS, cranial nerves, and brainstem (Dmax, D0.5cc, and V23) were evaluated in order to identify correlated late toxicity. The number of patients experiencing symptomatic pseudoprogression at any point post treatment was also recorded for each group. Clinical and radiographic data was available for 59 of the patients, and median follow-up was 33.5 months for the small VS group (range 5 – 76 months) and 15 months for the large VS group (range 2 – 49 months). The median treated volume for the small VS group was 0.9 cc (range 0.1 – 3.4 cc) and 5.2 cc for the large VS group (range 1.4 – 22.6 cc). The median brainstem Dmax was 16.5 Gy for the small VS group (range 1.1 – 28.4 Gy) and 26.1 Gy for the large VS group (range 21.7 – 30.4 Gy). The median D0.5cc was 4.75 Gy for the small VS group (range 0 – 21.7 Gy) and 20.5 Gy for the large VS group (range 9 – 23.8 Gy). The median V23 was 0.18 cc for the small VS group (range 0 – 0.33 cc) and 0.18 cc for the large group (0 – 0.62 cc). Tumor control was 100% in both groups, and there was no evidence of brainstem necrosis in either group. No patients experienced progression of trigeminal symptoms. Freedom from new facial neuropathy was 97.6% in the small VS group vs. 100% in the large VS group (p=0.99). Rates of pseudoprogression were 4.8% in the small VS group vs. 11.8% in the large group (p=0.13). Debulking surgery was performed in 2 of 42 patients in the small VS group and in 10 of 18 patients in the large VS group and was not found to affect any of these clinical outcomes. Patients with large VSs or with brainstem compression did not experience worse rates of tumor control, brainstem necrosis, pseudoprogression, or neuropathy compared to those with small VSs. Outcomes were similar for those treated with or without surgery, suggesting that FSR alone is a reasonable treatment option for patients with large VSs compressing the brainstem.

NMDA Receptor Antagonists for the Treatment of Neuropathic Pain Compared to Placebo: A Systematic Review and Meta-analysis

The objective of this study is to evaluate the efficacy of N-Methyl-D-aspartate (NMDA) receptor antagonists on neuropathic pain disorders that can occur in the orofacial region. These disorders included: Postherpetic Neuralgia (PHN), Complex Regional Pain Syndrome (CRPS), Atypical Odontalgia, Temporomandibular Joint (TMJ) Arthralgia and facial neuropathies. Materials and Methods: Three databases (Medline through PubMed, Web of Science, and Cochrane library) were searched on January 25, 2017 for randomized placebo-controlled studies using a NMDA receptor antagonist to treat spontaneously occurring neuropathic pains as compared to placebo. Two review authors separately evaluated the risk of bias. Results: The initial search yielded 267 unduplicated references, of which only 16 were eligible for inclusion. Six of these studies had an unclear risk of bias and ten had a high risk of bias. Four studies were included for meta-analysis. Oral memantine was found not to be more effective than placebo in treating PHN (p=0.735), while oral and IV ketamine were more effective than placebo in treating CRPS (p<.001). Conclusions: The quality of the evidence favorable to the use of ketamine in the treatment of CRPS is low. Inconclusive evidence in favor of other NMDA antagonist receptors was found. Additional studies with lower risk of bias and larger sample sizes are needed in this area of study.

Recurrent Bifacial Neuropathy in a Case of Steroid Responsive Neurosarcoidosis: A Case Report

Neurosarcoidosis is a rare or misdiagnosed disease that can be masked in a case with fl eeting neurologic defi cits, especially craniopathy. We present a 26-year-old Chinese-Filipino male who presented with recurrent facial neuropathy that was heralded by fl eeting blurring of vision bilaterally. He was apparently responsive to corticosteroids (intravenous and oral methylprednisolone) from initiation to date. During the course, he also noted selective weakness of the right fi nger fl exors. Nodules in the face eventually appeared that led to a biopsy disclosing a noncaseating granuloma. Apart from electrodiagnostic tests, a supportive diagnostic test for sarcoidosis was the presence of lymphadenopathies on his chest noted on Computed Tomography (CT) scan. Cerebrospinal fl uid (CSF) and brain Magnetic Resonance Imaging (MRI) tests were not yielding. To our knowledge, this was the fi rst reported Chinese-Filipino case of neurosarcoidosis involving cranial and peripheral nerves.

A novel variant of DHH in a familial case of 46,XY disorder of sex development: Insights from molecular dynamics simulations.

Disorders of sex development (DSD) are a heterogeneous group of conditions affecting the differentiation and development of the internal and external genitalia. Here, we aimed at identifying the genetic cause of DSD in two 46,XY sisters from a consanguineous family. We performed a whole-exome sequencing of two 46,XY female individuals. Sanger sequencing was used to validate the most likely candidate variant, affecting the desert hedgehog (DHH) gene. Molecular dynamics simulations were performed to get insights into the impact of the variant on protein structure and on its interaction with the protein partner BOC (brother of CDO/cell adhesion molecule, downregulated by oncogenes). The index patient presented with a female phenotype, primary amenorrhoea (low oestradiol and testosterone and high FSH and LH). She also had an apparent absence of intra-abdominal gonads and uterus, facial dysmorphy, psychomotor retardation and neuropathy. Her sister displayed a similar gonadal and endocrinological picture, without dysmorphy or psychomotor retardation. Whole-exome sequencing revealed a homozygous variant in DHH leading to the p.Trp173Cys substitution. The relevant Trp residue is conserved, and its alteration was predicted to be deleterious. Molecular dynamics simulations showed that the mutation increases the conformational flexibility of the protein and potentially alters its interaction with BOC, a positive regulator of Hedgehog signalling. We do not exclude an interference of the mutation with DHH-intein-mediated auto-processing. This report increases the number of described homozygous DHH variants and highlights the importance of advanced bioinformatic tools to better understand the pathogenicity of human variants.

Hepatitis E virus infection and acute non-traumatic neurological injury: A prospective multicentre study

Hepatitis E virus (HEV) has been associated with a number of neurological syndromes, but causality has not yet been established. The aim of this study was to explore the relationship between HEV and neurological illness by prospective HEV testing of patients presenting with acute non-traumatic neurological injury. Four hundred and sixty-four consecutive patients presenting to hospital with acute non-traumatic neurological illnesses were tested for HEV by serology and PCR from four centres in the UK, France and the Netherlands. Eleven of 464 patients (2.4%) had evidence of current/recent HEV infection. Seven had HEV RNA identified in serum and four were diagnosed serologically. Neurological cases in which HEV infection was found included neuralgic amyotrophy (n=3, all PCR positive); cerebral ischemia or infarction (n=4); seizure (n=2); encephalitis (n=1); and an acute combined facial and vestibular neuropathy (n=1). None of these cases were clinically jaundiced and median ALT at presentation was 24IU/L (range 8-145). Cases of HEV-associated neuralgic amyotrophy were found in each of the participating countries: all were middle-aged males with bilateral involvement of the brachial plexus. In this cohort of patients with non-traumatic neurological injury, 2.4% had evidence of HEV infection. Symptoms of hepatitis were mild or absent and no patients were jaundiced. The cases of HEV-associated neuralgic amyotrophy had similarities with other HEV-associated cases described in a large retrospective study. This observation supports a causal relationship between HEV and neuralgic amyotrophy. To further understand the relevance of HEV infection in patients with acute neurological illnesses, case-control studies are warranted. Lay summary: Hepatitis E virus (HEV), as its name suggests, is a hepatotropic virus, i.e. it causes damage to the liver (hepatitis). Our findings show that HEV can also be associated with a range of injury to the nervous system.

Facial Nerve Neuropathy Caused by its Stretching

Purpose. Study the dynamics of changes in electrophysiological parameters of the facial nerve in cases after operative interventions on the parotid and submandibular glands, as well as determine the possibility of using electrical stimulation of the nerve on the hardware-software complex “DIN-1” for the treatment of neuropathy caused by its stretching. Patients and Methods. 31 patients were examined after surgery on the parotid and submandibular glands. Results. Based on the performed patient examinations after parotidectomy and extirpation of the submandibular glands, it was established that in the postoperative period they may have neuropathy of the facial nerve, the cause of which is the stretching of the nerve. Clinical improvement and elimination of symptoms were correlated with normalization of electrophysiological indices of the state of affected branches of the facial nerve. Conclusions. Due to the use of the hardware-software complex “DIN-1” for diagnosis and treatment of the facial nerve neuropathy caused by its stretching, we managed not only to identify and prove the existence of this disease, but also to shorten the terms of rehabilitation of patients 4 times.

New Treatment in Facial Nerve Palsy Caused by Sagittal Split Ramus Osteotomy of Mandible.

A 25-years-old woman with mandibular prognathism underwent a mandibular setback by way of mandibular sagittal split ramus osteotomy (MSSRO). After 2 days of operation, she developed difficulty of closing her right eye. The blink reflex test and motor nerve conduction study of the right orbicularis oris muscle were revealed right facial neuropathy of unknown origin and House-Brackmann facial nerve grading system (HBFNGS) grade V. For treatment, we initially prescribed oral prednisolone and nimodipine including physical therapy. The samples consisted of 11 facial nerve palsy patients caused by MSSRO and were analysed about onset of facial nerve palsy, postoperative HBFNGS, final HBFNGS, treatment method and recovery time. At 10 weeks of treatment of nimodipine, she had completely regained normal function (HBFNGS grade I) of the right facial nerve. The clinical results lead to assume a fast recovery of facial nerve function by the nimodipine medication, whereas average time of recovery is 16.32 weeks in references. Despite of the limited one patient treated, the result was very promising with respect to a faster recovery of the facial nerve function. Considering the use of nimodipine treatment for peripheral facial nerve palsy following a surgical approach with an anatomically preserved nerve can be recommended.

Numb chin syndrome as a primary presentation of metastatic breast cancer

Numb chin syndrome (NCS) is characterized by facial neuropathy along the distribution of the mental branch of the trigeminal nerve. We report a case of NCS in a 65 year old woman who initially presented to her dentist with nonspecific symptoms that she thought were related to a tooth infection. The patient was otherwise healthy and her medical history was significant for breast cancer treated 20 years prior; her cancer was thought to be in complete remission. Upon clinical examination and conventional dental radiography, no pathology was seen such as odontogenic, periodontal, or jawbone infection. Only paresthesia and hypoesthesia was noted unilaterally in her left chin, jaw and lower lip. A computed tomography scan was obtained for further evaluation and revealed lytic metastatic disease involving the right mandible at the level of the mandibular foramen; lytic lesions of the thoracic vertebrae and multiple pulmonary nodules were also noted. Oncologic referral was made immediately which confirmed a diagnosis of metastatic breast cancer. Familiarity with NCS is important for oral health care providers in order to identify etiology and differential diagnosis, as well as to provide appropriate referral and management.

Neurosonography of the facial nerve in children with idiopathic neuropathy of facial nerve

To find the correlation between neurophysiological and neurosonographic (NSG) parameters of the facial nerve of children with idiopathic neuropathy of the facial nerve (NLN) in the acute period with good and poor prognosis of recovery of facial nerve function. Sixty-five children with NLN (mean age 11.5±4.9 years) and 57 children of control group (mean age 12.5±5.2 years) were examined. All children with NLN were studied using NSG with the measurement of the diameter of the facial nerve in the area of processus stylomastoideus and in the parotid gland. Stimulation electroneuromyography of the facial nerve with the registration of the M-response from the m. orbicularis oculi and evaluation of the degree of paresis of facial muscles using the 6-point House-Brackmann scale on the 10-15 day were performed. On the 30th day after manifestation of paresis, children with NLN were divided into two groups: the good recovery group 1 (n=54) and the poor prognosis recovery group (n=11). Correlation between NSG and electroneuromyography indicators with good and poor prognosis of recovery of facial nerve function was analyzed. Based on the results obtained, 85% sensitivity and 77% specificity of measuring the diameter of the facial nerve using NSG in predicting poor prognosis of recovery of facial nerve function was shown. Normative and thresholds NSG parameters of the facial nerve in children were obtained.

Radiotherapeutic management of vestibular schwannomas using size- and location-adapted fractionation regimens to maximize the therapeutic ratio

BackgroundWe evaluated and compared the radiographic and clinical outcomes of patients with vestibular schwannomas treated with single fraction stereotactic radiosurgery (SRS), 5 fractions of hypofractionated stereotactic radiation therapy (hSRT), or 25 to 30 fractions of conventionally fractionated stereotactic radiation therapy (cfSRT). Methods and materialsFifty-six patients treated with LINAC-based SRS (median, 12.5 Gy), hSRT (25 Gy), or cfSRT (median, 54 Gy) were retrospectively reviewed. Fractionation was based on the size of the tumor, proximity to the brainstem, and potential risk of neurological sequelae. Median follow-up time was 55.2 months. ResultsThe pretreatment median tumor diameter was significantly smaller for SRS (1.14 cm) compared with hSRT (1.7 cm) (P = .03) and cfSRT (2.0 cm) (P < .001). The overall local tumor control was 96.4%: 100% SRS, 100% hSRT, and 90% cfSRT (P = .19). Tumor regression was observed in 53.3% of SRS, 76.2% of hSRT, and 90% of cfSRT (P = .05). There was less transient expansion of tumors treated with cfSRT (5%) than with SRS (53.3%) or hSRT (28.6%) (P = .005). The median time to regression was 13.8 months for SRS, 14.2 months for hSRT, and 5.5 months for cfSRT (P = .34). There was a 3.6% incidence of grade 3 trigeminal neuropathy, but there was no grade 3 facial neuropathy. ConclusionsAll 3 regimens demonstrated similar excellent local control with minimal toxicity; however, the ability of hSRT to treat larger tumors with comparable outcomes to SRS and greater patient convenience when compared with cfSRT suggest that hSRT may offer the optimal treatment approach.

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

OBJECTIVE The goal of this retrospective cohort study was to assess long-term outcomes in patients with vestibular schwannoma (VS) who underwent stereotactic radiosurgery (SRS) after initial microsurgical resection. METHODS From the authors' database of 1770 patients with VS, the authors retrospectively analyzed data from 173 Gamma Knife SRS procedures for VS after 1 (128 procedures) or multiple (45 procedures) microsurgical resections. The median length of the interval between the last resection and SRS was 42 months (range 2-329 months). The median length of clinical follow-up was 74 months (range 6-285 months). Progression-free survival after SRS was determined with Kaplan-Meier analysis. RESULTS At the time of SRS, the hearing of 161 patients (93%) was Gardner-Robertson Class V, and 81 patients (47%) had facial neuropathy (i.e., facial function with House-Brackmann [HB] grades of III-VI), 87 (50%) had trigeminal neuropathy, and 71 (41%) reported imbalance or disequilibrium disorders. The median tumor volume was 2.7 cm3 (range 0.2-21.6 cm3), and the median dose to the tumor margin was 13 Gy (range 11-20 Gy). Radiosurgery controlled growth of 163 (94%) tumors. Progression-free survival after SRS was 97% at 3 years, 95% at 5 years, and 90% at 10 years. Four patients with delayed tumor progression underwent repeat SRS at a median of 35 months (range 23-64 months) after the first SRS. Four patients (2.3%) with tumor progression underwent repeat resection at a median of 25 months (range 19-33 months). Among the patients with any facial dysfunction (indicated by HB grades of II-VI), 19% had improvement in this condition after SRS, and 5.5% with some facial function (indicated by HB grades of I-V) developed more facial weakness. Among patients with trigeminal neuropathy, 20% had improvement in this condition, and 5.8% developed or had worsened trigeminal neuropathy after SRS. CONCLUSIONS Stereotactic radiosurgery offered a safe and effective long-term management strategy for VS patients whose tumors remained or recurred after initial microsurgery.

30. Facial neuropathy as the initial manifestation of chronic inflammatory demyelinating polyradiculopathy

We report the clinical and electrophysiological features of a patient who presented unilateral facial weakness as the initial manifestation of chronic inflammatory demyelinating polyradiculopathy (CIDP). A 40-year-old man presented facial numbness and weakness. Examination demonstrated severe unilateral facial weakness with no other cranial or segmental clinical abnormalities. Blink and jaw-jerk reflex latencies were prolonged bilaterally, with a reduction of R1 amplitude recording by the symptomatic side. Somatic neurophysiological examination showed slowing of motor nerve conduction velocities, lengthening of distal motor latencies, prolonged minimal F wave latencies and partial conduction motor block, without any unusual sensory electroneurophysiological abnormalities. Cerebrospinal fluid demonstrated an elevated protein level. After 1 week of intravenous immunoglobulin treatment, the symptoms and electrophysiological findings improved. This case could represent an unusual initial presentation of isolated cranial nerve involvement in asymptomatic CIDP. Blink reflexes may be a useful electrophysiological technique to assess for peripheral nerve demyelination in patients with suspected CIDP.

Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies

We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema.

Facial and vestibular neuropathy of unknown origin in 16 dogs.

The aim of this study was to describe the signalment, clinical presentation, diagnostic findings and long-term follow-up in dogs with concomitant facial and vestibular neuropathy of unknown origin. Appropriate cases were located through medical record searches. Inclusion criteria comprised dogs that had: clinical signs of facial paralysis with concomitant peripheral vestibular syndrome, thyroid function tests, no abnormalities on magnetic resonance imaging of the brain and tympanic bullae, and cerebrospinal fluid analysis. Sixteen dogs met the inclusion criteria. Facial paralysis had acute onset (<24 hours) in all dogs, thyroid function was within normal limits. There was albuminocytologic dissociation in cerebrospinal fluid of 69% of the dogs. There was complete resolution of clinical signs in 31% of the dogs but 38% showed long-term vestibular deficits, 46% developed hemifacial contracture, 15% had permanent facial paralysis and 15% relapsed. Facial and vestibular neuropathy of unknown origin shares similarities with idiopathic facial paralysis. The prognosis for return of normal facial and vestibular function is guarded and there may be relapse after recovery.

Congenital Cataract With Facial Dysmorphism and Neuropathy: Key Clinical Features

Congenital cataracts and peripheral neuropathy occur in several disorders. 1 Kalaydjieva L. Chamova T. Congenital cataracts, facial dysmorphism, and neuropathy. in: Pagon R.A. Adam M.P. Bird T.D. Dolan C.R. Fong C.T. Stephens K. GeneReviews. University of Washington, Seattle, Seattle2010: 1993-2013 Google Scholar Some additional clinical features can guide the molecular diagnosis.

Reabilitacijos metodai esant veidinio nervo neuropatijai

Asmenys, kenčiantys nuo veidinio nervo neuropatijos, dažniausiai skundžiasi veido raumenų tonuso sumažėjimu, nesugebėjimu užmerkti akies, išnykusia nasolabialine raukšle, burnos kampo svirimu. Tai daro žalą ne tik fizinei, bet ir psichosocialinei žmogaus gerovei, todėl labai svarbu užtikrinti tinkamą, efektyvų gydymą ir atgauti prarastas funkcijas. Literatūroje pateikiami įvairūs reabilitacijos metodai ir strategijos, aprašomas jų veiksmingumas, įrodantis reabilitacijos svarbą atgaunant veidinio nervo funkciją. Reabilitacijos metu dažniausiai naudojamas funkcinių pratimų ir masažo derinys, tačiau pastebėtas ir kitų priemonių, tokių kaip botulino toksino injekcijos, teipavimo, elektrostimuliacijos ir akupunktūros veiksmingumas, siekiant paskatinti veidinio nervo regeneraciją. Teigiamas terapinis efektas po reabilitacijos stebimas ne iš karto - tai gali užtrukti nuo kelių savaičių iki kelerių metų, gautas rezultatas pagerina savijautą ir gyvenimo kokybę. Straipsnyje aptariami efektyviausi, moksliniais tyrimais pagrįsti reabilitacijos metodai, taikomi esant veidinio nervo neuropatijai ir su ja susijusiom pasekmėm.

Dopaminergic medicines are drugs of choice for medicament-resistant facial nerve neuropathy: EMG study

Dopaminergic medicines are drugs of choice for medicament-resistant facial nerve neuropathy: EMG study

Dopaminergic medicines are drugs of choice for medicament-resistant facial nerve neuropathy

Dopaminergic medicines are drugs of choice for medicament-resistant facial nerve neuropathy