A facial nerve study using transcranial magnetic paired stimulation

Objective: The purpose of this study was to evaluate the refractory period of the facial nerve by transcranial magnetic paired stimulation (TMPS) with as short interstimulus interval (ISI) as possible. Also, by applying TMPS, the long latency response obtained at the same time was recorded and its neurophysiological characteristics were studied. Methods: (Experiment 1) The subjects comprised of 30 normal volunteers and 19 patients with Bellʹs palsy. The experiments were carried out using two sets of Magstim model 200 and Bistim modules, a large coil measuring 90 mm in diameter with a maximal output of 2.0 tesla (T), and a Neuropack 8 (Nihon Kohden Co., Japan) to control the stimulation and record the electromyographic findings. The amplitude of compound muscle action potentials (CMAP) to the orbicularis oris muscle was studied by TMPS at the parieto-occipital region. The ISI was set at 0.9, 1.1, 1.3, 1.5, 1.7, 1.9 and 2.1 ms in order to measure the refractory periods of the nerve. (Experiment 2) The subjects comprised of ten normal volunteers. The same method as in experiment 1 was carried out. However, this time, the lead electrodes were placed on the orbicularis oculi muscle, similar to that of the blink reflex. The ISI was set at 40, 60, 80, 100, 200, 300, 500, 800 and 1000 ms, and the effects of the facilitation and inhibition were studied. Results: (Experiment 1) In normal subjects, when the ISI was less than 1 ms, a significant decrease in the amplitude was noted. In severe palsy cases with House–Brackmann Grade IV–V TMS yielded no response. In two of the cases of House–Brackmann Grade III, the CMAP was obtained. (Experiment 2) The long latency response with TMPS was most strongly inhibited when ISI was 80 ms. Conclusion: We were able to investigate the refractory periods, the reflex pathway of the facial nerve and the trigeminal nerve including the pons and the medulla oblongata by TMPS.