Agreement between clinical and electromyographic assessments during the course of peripheric facial paralysis

Abstract

Objective: To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement.

Design: Serial clinical and electromyographic assessments were performed.

Settings: Physical Medicine and Rehabilitation Department of a university hospital.

Subjects: Thirty patients with acute complete idiopathic facial paralysis were included.

Main measures: Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa (kappa) statistics were performed to measure the agreement between clinical and electromyographic assessments.

Results: Agreement between assessments yielded an overall kappa value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall kappa value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles.

Conclusions: Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.