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(Cfp) After Ischemic Stroke a Relevant Size? the Prevalence

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(Cfp) After Ischemic Stroke a Relevant Size? the Prevalence Neurology and Neurosurgery Research Article ISSN: 2631-4339 Is the number of Central Facial Palsy (cFP) after ischemic stroke a relevant size? The prevalence of cFP after ischemic stroke: A prospective study Annegret Lorenz1,2, Orlando Guntinas-Lichius3 and Farsin Hamzei1,2* 1Moritz Klinik Bad Klosterlausnitz, Hermann-Sachse-Strasse 46, 07639 Bad Klosterlausnitz, Germany 2Section of Neurorehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany 3Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany Abstract Background and purpose: The central facial palsy (cFP) after stroke is associated with a deficit of the voluntary movements of the lower face contralateral to the lesioned hemisphere. The facial expression is reduced, and the communication is limited. Emotional interaction, muscular control and the quality of life are negatively affected. Therefore, the question arises whether the number of cFP after ischemic stroke is a relevant size that we have to deal with. Method: To the best of our knowledge, there is no study that reported the prevalence of cFP after first ever ischemic stroke. Therefore, in this prospective study we calculated the 1-year prevalence of cFP after ischemic stroke in 2019. Results: With the consideration of the exclusion and inclusion criteria from 416 patients 155 patients showed cFP (prevalence of 37.3%). 78.7% of patients with cFP had a stroke within the supply area of the middle cerebral artery. Conclusion: With such a high prevalence number, it is important for physicians and therapists to consider the clinical consequence of cFP. Evidence-based studies concerning a rehabilitation strategy to improve cFP are still lacking. Consequently, for the future, studies are necessary to effectively support the recovery process of cFP. Abbreviations: ACA: Anterior Cerebral Artery; cFP: The Central Materials and methods Facial Palsy; MCA: The Middle Cerebral Territory; MT: Multiple Ter- ritories; PCA: The Posterior Territory; PR: Prevalence Rate. Study population Patients after first ever ischemic stroke, admitted to the Moritz Introduction Klinik, were included from 1 January 2019 to 31 December 2019. After ischemic stroke, the central facial palsy (cFP) is accompanied The Moritz Klinik is an inpatient rehabilitation center of neurology, by a deficit of the voluntary movements of the lower face contralateral located in Thuringia (middle-east of Germany). In the specified to the lesioned hemisphere while a limited mobility of the upper period each patient with a stroke diagnosis was included in the first hemi-face is usually absent. The classic explanatory model describes stage of this prospective study. Exclusion criteria were: hemorrhage, previous ischemic stroke, stroke longer than six months ago, previous bilateral corticonuclear projections from each primary motor cortex peripheral and / or cFP, lack of compliance with the examination, to the motoneurons innervating the upper facial muscles and unique vigilance dysfunction, other concomitant disease which affects the contralateral projections to the motoneurons innervating the lower central nervous system, e.g. Multiple Sclerosis, traumatic brain facial muscles. injury etc. During the one-year registration 479 stroke patients in With cFP the facial muscular activity is reduced and consequently, total were included. Considering inclusion and exclusion criteria communication, facial expression, daily food intake and control of 63 patients were excluded from the total number (n = 41 because of saliva could be compromised [1]. With reduced facial feedback the concomitant diseases, n = 11 due to vigilance dysfunction, and n = 10 lack of compliance to the examination and one patient with confused related neural activity of emotions is also abnormally modulated [2,3]. information regarding stroke localization that was not fit to the side of These circumstances have a negative influence on the quality of life [4,5]. So, there are enough reasons to investigate in detail the number of cFP as a relevant variable. To the best of our knowledge, there are no studies that reported the prevalence of cFP after first ever ischemic *Correspondence to: Farsin Hamzei, Moritz Klinik, Hermann-Sachse-Str. 46, 07639 Bad Klosterlausnitz, Germany, Tel: +493660149471, E-mail: farsin. stroke. This is the first study in Germany that investigates the prevalence [email protected] of cFP after supranuclear lesion. With a high prevalence value of cFP, there is a subsequent necessity to provide all patients suffering from Key words: ischemic stroke, prevalence, central facial palsy cFP with additional specific rehabilitative therapy. Received: July 09, 2020; Accepted: July 16, 2020; Published: July 22, 2020 Neuro Neurosurg, 2020 doi: 10.15761/NNS.1000134 Volume 4: 1-3 Lorenz A (2020) Is the number of Central Facial Palsy (cFP) after ischemic stroke a relevant size? The prevalence of cFP after ischemic stroke: A prospective study hemiparesis). Consequently, 416 patients (161 females, 255 males; age: 19-92 years) fulfilled all criteria and were included in the final analysis. Stroke localization Diagnosis of Stroke was made based on the criteria of guidelines of the German Society of Neurology (www.dgn.org/leitlinien). According to the stroke localization obtained by CCT (n = 231), MRI (n = 185) or both (n = 298), we divided stroke patients into five categories: 1. the anterior territory (ACA; brain regions which are supplied by the anterior cerebral artery), 2. supply area of the middle cerebral artery (the middle cerebral territory, MCA), 3. the posterior territory (PCA; brain regions in relation to vertebral artery, basilar artery, posterior inferior cerebellar artery and posterior cerebral artery), 4. multiple territories (MT) referring to patients with multilocular infarction and 5. patients without stroke demarcation in neuroimaging (NO). Diagnosis of cFP Each patient who met the related exclusion and inclusion criteria was tested. The following examinations were performed: patients were asked to look forward without any facial movement to evaluate if there is a facial asymmetry in rest. Patients, who indicated a former asymmetry not due to pathological causes were compared with their German National Identity Card (ID) to rule out a false positive diagnosis of a cFP in case of a natural innate facial asymmetry. With accordance and normal voluntary facial movements as described below, patients were labeled as clinically unremarkable due to cFP. To assess the voluntary facial movement patients were requested to perform the following movements: to close their eyes gently, to squint their eyes, to raise the eyebrows, to knit the eyebrows, to wrinkle the nose, to smile with closed lips, to show teeth (to snarl), to bring the lips forward, to pull the corners of their mouth downward. We assessed facial asymmetry at rest and of single facial movements by comparing both sides of face. cFP was diagnosed when there was a difference between both sides. Figure 1. A) Distribution of patients in total and those with cFP in relation to stroke territories. B) Categorization of age with the related distribution of patients in total and Results those with cFP All acronyms are explained in the section methods. Prevalence of cFP One patient showed a peripheral facial paresis after a brain stem During the one-year registration 479 stroke patients in total and cerebellar lesion (4.2% of all patients within PCA category) and were included. Considering inclusion and exclusion criteria 63 were excluded from cFP cluster. patients were excluded from the total number (n = 41 because of concomitant diseases, n = 11 due to vigilance dysfunction, and n = 10 Discussion lack of compliance to the examination and one patient with confused information regarding stroke localization that was not fit to the side of cFP after ischemic stroke is a relevant number with a prevalence of 37.3%. To the best of our knowledge, there is no prospective study that hemiparesis). Consequently, 416 patients (161 females, 255 males; age: reported the prevalence of cFP after first ever ischemic stroke. 19-92 years) fulfilled all criteria and were included in the final analysis. A previous study reported 28 out of 47 stroke patients had cFP 260 patients did not show any paresis of facial movement. From (59.6%). This study, however, focused on analyzing the association these patients 22 had initially a false positive diagnosis (8.5%), because between pattern of facial movement and their stroke localization (6). considering their IDs their lower face asymmetry already existed before the stroke. These patients were considered as patients with a natural Some studies investigated the prevalence of pure isolated facial innate facial asymmetry. paresis-dysarthria syndrome and found 11 out of 2,000 (0.55%) stroke patients showed corresponding clinical symptoms (7). Another study 155 (61 females, 94 males) demonstrated a cFP (37.3%). Their time found a prevalence of 0.4% by searching a database with more than between stroke and evaluation of cFP was between seven- and 135-days 2,000 stroke patients (8). All our cFP patients had additional clinical post onset of stroke symptoms, with a mean of 24 days. symptoms (e.g. hemiparesis) and we did not find an isolated facial paresis-dysarthria syndrome. This discrepancy might be due to the The number of patients with cFP was most after stroke in the MCA lower number of patients we included. In our prospective study, group (78.7%). Age distribution of stroke patients without and with we included 416 patients in one year, while other studies analyzed cFP were similar. For stroke localization and age distribution (Figure 1). retrospectively their database over the past six and four years. Neuro Neurosurg, 2020 doi: 10.15761/NNS.1000134 Volume 4: 2-3 Lorenz A (2020) Is the number of Central Facial Palsy (cFP) after ischemic stroke a relevant size? The prevalence of cFP after ischemic stroke: A prospective study It must be considered that from clinical aspects cFP recovers fast Katharina Herzog, Lisa-Marie Jacob, Patricia Klöpfel, Kati Matterne, during the first days after stroke.
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