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  • Küçük Resim
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    Changes in the perioral muscle responses to cortical TMS induced by decrease of sensory input and electrical stimulation to lower facial region
    (Elsevier Ireland Ltd, 2004) Yıldız, Nebil; Yıldız, Serpil; Ertekin, Cumhur; Aydoğdu, İbrahim; Uludağ, Burhanettin
    Objective: To determine the changes in the motor cortex due to repetitive electrical stimulation and cutaneous anesthesia in lower facial region. Methods: A total of 11 subjects participated in the study of repetitive electrical stimulation, and 10 other subjects in the study of lower facial anesthesia. Facial nerve root and face associated cortical MEPs by transcranial magnetic stimulation (eight-shaped coil) were recorded from perioral muscles pre- and post- electrical stimulation and lower facial anesthesia. Cheek near to the corner of the mouth was transcutancously stimulated by bipolar surface electrode giving repetitive electrical shocks at 5 Hz. Five percent lidocain/prilocain local anesthetic cream was applied to left or right lip-cheek region. Results: There was no sianificant change in perioral MEP responses after 10-30 min of 5 Hz electrical stimulation. We found a significant increase of amplitude in cortical MEP recordings during lower facial anesthesia especially in cases of cortical magnetic stimulations ipsilateral and contralateral to the anaesthetized side and in perioral recordings contralateral to the anaesthetized side. Conclusions: The present study demonstrates that topical anesthesia to the lower facial region leads to cortical modulation and fast plastic changes in both hemispheres that are directed to the normal side.
  • Küçük Resim
    Öğe
    Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis
    (Springer Heidelberg, 2005) Yıldız, Nebil; Ertekin, Cumhur; Özdemirkıran, Tolga; Yıldız, Serpil Kuyucu; Aydoğdu, İbrahim; Uludağ, Burhanettin; Seçil, Yaprak
    Recently it has been proposed that corticobulbar innervation of the lower facial muscles is bilateral, that is from both right and left sides of the motor cortex. The objectives of this study were, i) to evaluate the corticonuclear descending fibers to the perioral muscles and, ii) to determine how central facial palsy (CFP) occurs and often recovers rapidly following a stroke. Eighteen healthy volunteers and 28 patients with a previous history of a stroke and CFP (mean ages: 51 and 61 years) were investigated by TMS (transcranial magnetic stimulation) with a figure of eight coil. Intracranial facial nerve and cortical motor evoked potentials (MEPs) were recorded from the perioral muscles. The periorbital MEPs were also studied. The absence of MEPs in both perioral muscles with TMS of the affected hemisphere was the most obvious abnormality. Also, central conduction time was significantly prolonged in the remaining patients. The mean amplitude of the affected hemisphere MEPs was diminished. The amplitudes of the unaffected hemisphere MEPs recorded from the intact side were enhanced especially in the first week following the stroke. During TMS, only the blink reflexes were elicited from the periorbital muscles due to stimulus spreading to trigeminal afferent nerve fibers. It is concluded that perioral muscles are innervated by the corticobulbar tract bilaterally. CFP caused by a stroke is generally incomplete and mild because of the ipsilateral cortical and multiple innervations out of the infarction area, and recovers fast through cortical reorganisation.