PROGNOSTIC VALUE OF ELECTRONEUROMYOGRAPHY AND PROINFLAMMATORY CYTOKINES FOR EARLY PREDICTION OF LATE COMPLICATIONS IN FACIAL NERVE NEUROPATHY
Keywords:
facial nerve neuropathy, Bell's palsy, ENMG, IL-6, IL-8, TNF-alpha, House–Brackmann, prognosis, mumiyo electrophoresisAbstract
Relevance. Early and objective prediction of late complications of facial nerve neuropathy (FNN) – facial synkinesis and contracture of the mimic muscles – remains one of the pressing problems of modern neurology.
Objective. To predict the development of complications early and to improve rehabilitation outcomes in FNN through a combined assessment of electroneuromyographic (ENMG) and immunological (IL-6, IL-8, TNF-α) parameters.
Materials and methods. At the 1st Clinic of Tashkent State Medical University, 48 patients with FNN (30 aged under 45 years, 18 aged over 45 years; 20 men, 28 women) and 25 apparently healthy controls were examined. Clinical status was assessed with the House–Brackmann (HB) and FNGS 2.0 scales, neurophysiological status by ENMG, and cytokine levels by enzyme-linked immunosorbent assay (ELISA). Patients with low rehabilitation potential (n=21) were allocated to two groups; in one of them (n=11), 4% mumiyo electrophoresis was added to conventional therapy.
Results. In the acute phase (0–72 h), serum IL-6 (18.6±1.8 pg/mL), IL-8 (34.2±3.1 pg/mL), and TNF-α (15.4±1.2 pg/mL) were significantly higher in FNN patients than in controls (p<0.001). Patients who developed late complications (n=9; 18.8%) had higher baseline IL-6 (24.8 pg/mL) and TNF-α (21.2 pg/mL) and a greater M-response amplitude reduction (78%) than those without complications. The proposed prognostic cut-off values were an M-response reduction >75%, IL-6 >20 pg/mL, IL-8 >35 pg/mL, and TNF-α >18 pg/mL. Adjuvant mumiyo electrophoresis significantly improved HB and FNGS 2.0 scores (p<0.05); the complication rate was 9.1% versus 30.0% with conventional therapy, although this difference was not statistically significant (p=0.31).
Conclusion. Combined use of ENMG and proinflammatory cytokines (IL-6, IL-8, TNF-α) provides high diagnostic accuracy for the early prediction of late complications in FNN. Mumiyo electrophoresis appears promising, but its efficacy needs to be confirmed in larger samples.
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