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A clinical study on the magnetic stimulation of the facial nerve

Objectives: A clinical study on the usefulness of magnetic stimulation of the facial nerve, with special attention paid to the selection of the coil shape and stimulation procedures. Study Design: The subjects consisted of 55 patients with Bell's palsy, 1 patient with a cerebellopontine angle (CPA) tumor, 1 patient with multiple sclerosis (MS), and 30 normal subjects. Three types of coils were used in this study; a 90‐mm large single coil, a 40‐mm small single coil, and a 20‐mm small double coil. Methods: The compound muscle action potentials (CMAPs) and long latency response were evoked by transcranial magnetic stimulation (TMS) with a 90‐mm large single coil. The 40‐mm small single coil was used to test blink reflex by aiming it at the supraorbital nerve as the target site. The subcutaneous activation of the infra‐auricular facial nerve was performed with the 20‐mm double coil. Results: The reproducible CMAP and long latency responses were obtained from normal subjects with TMS. However, responses were observed only in patients with relatively mild Bell's palsy. The magnetic stimulation—evoked responses reflected the brainstem function in the patients with a CPA tumor and MS. Conclusion: Although magnetic stimulation remains inferior to conventional electric stimulation in some sense and requires further study, this method is potentially useful because it can stimulate the facial nerve continuously from the cortex to the periphery and can effectively evoke responses reflecting the brainstem function.