Facial nerve paralysis is the most common form of peripheral paralysis. Within this group, Bell’s palsy is the most common. Regarding facial paralysis, its cause and possible treatments, I wrote extensively in my previous article. The most effective treatments are physiotherapy, electrotherapy and soft laser treatment. In this article, I will describe the electrical treatment of peripheral facial nerve paralysis.
The treatment for peripheral facial paralysis is referred to as denervated treatment. Denervated means: a muscle that has “lost” its motor nerve.
I will mention two devices for stimulation treatment. The first is the German PeroBravo device, the second is the Genesy family of devices from the Italian manufacturer Globus.
PeroBravo is a single-channel device designed for treating peripheral paralysis, facial nerve paralysis and Bell’s palsy. The Genesy models, on the other hand, are 4-channel multifunctional electrotherapy devices, treating peripheral paralysis as one of their functions, but also helping to treat hundreds of other problems.
The PeroBravo offers an amazing “arsenal” of options for the treatment of peripheral paralysis and Bell’s palsy. This wealth of possibilities can only be exploited by professionals with extensive electrotherapy experience. The layperson can only make use of the basic settings.
The Genesis does not offer special settings for denervated programs. The basic programs are in most cases excellent in spite of this and the extra functions and the 4 channels make them a good choice, especially if there are other musculoskeletal problems.
Denervated treatment
When you become paralysed, it’s common for specialist clinics to give you some electrical treatments. Usually for 5-10 days. This treatment in the surgery is certainly not enough, as it takes 3-4 months for facial nerve paralysis symptoms to disappear, even in the best of cases, but most often it takes 6-8 months.
The ideal number of treatments is not one a day, but 3-4.
This cannot be carried out in a doctor’s office; it must be performed at home. To do this, you should buy a stimulator for the purpose.
Facial paralysis primarily results from peripheral paralysis, leading to muscle denervation (loss of motor nerve).
Peripheral paralyzed muscles cannot be stimulated by just any stimulator. You should get a device capable of delivering a slow, long pulse, ideally lasting at least 200-400 milliseconds, which is almost half a second. This treatment, known as denervated treatment, is essential for proper stimulation.
The device you buy at Lidl is certainly not suitable for treating the facial nerve and facial muscles.
PeroBravo stimulator
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- an electrotherapy device
- denervated treatment – triangle, trapezoidal, square wave
- healthy muscle treatment – biphasic square wave
- ETS (EMG based) – biofeedback triggered stimulation
- time/intensity (i/t) testing support
- gait relearning function with foot sensor (peroneal palsy)
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The PeroBravo device is manufactured by the German company MTR Plus, based in Berlin. In Germany, doctors prescribe it for cases of peripheral paralysis.
PeroBravo is specifically designed to address peripheral paralysis (paresis). Programs 1-10 are tailored to correspond with the progression of the paralysis.
Program 1 is for the most severe, complete nerve damage, and then optimised for less and less damaged nerve as the number of programs increases.
This means that in the case of total nerve damage, treatment should start with programme 1 and progress to programme 2 and then to programme 3 every few weeks, depending on the improvement, and so on. Continue with the treatment until the nerve has recovered and can be stimulated with program 10, which is specifically designed for healthy muscle-nerve connections.
We must note, that not all peripheral paresis is complete nerve damage!
Treatment programs of PeroBravo
Therefore, in each case, a different programme will be appropriate to start with. In the case of a partially damaged nerve, program 1 means a pulse that is too long, which is uncomfortably long and uncomfortable (and unnecessary) for the nerve. In this case, one of the higher-numbered programs may be more appropriate.
If you are a physiotherapist, you can do an intensity/duration curve. The PRG 12 provides an automated diagnostic program for this. The practitioner can accurately determine the optimal treatment parameters for a given patient.
In general, your doctor/physiotherapist should tell you which programme is right for you. If specific instructions for the device have not been provided, you should follow to this strategy:
- Start Program 07 first.
If you feel a subtle twitching of the muscles, no further attempt is needed, continue with this treatment.
If you don’t feel the muscles contract, switch to Program 06. - If you don’t feel a twitch with 06 either, then go to 05. Keep going like this until you get to 01. You will only need the latter in the most serious case, in case of complete nerve damage. The less severe the nerve damage, the closer you will be to 07.
- Whichever muscle contraction feels good, continue with that one.
Genesy 600, 1500 and 3000 devices
The Genesy devices are made by Globus, the best quality manufacturer in Europe. Genesy devices are multifunctional electrotherapy devices that can treat hundreds of problems. Treating peripheral paresis is just one of them.
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- multifunctional electrotherapy device
- TENS | EMS, NMES, FES | MENS, MCR | Ionto | Denervated
- max. 4 channels (8 electrodes)
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- multifunctional electrotherapy device
- TENS | EMS, NMES, FES | MENS, MCR | Ionto | Denervated | Interferential | Kotz
- max. 4 channels (8 electrodes)
- battery | mains operation
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For professionals, the device’s more than 400 programs can help treat, repair, cure or prevent thousands of problems.
[message title=”Genesy 3000 multifunction electrotherapy device” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]
- Multifunctional Electrotherapy Device
- TENS | EMS, NMES, FES | MENS, MCR | Ionto | Denervated | Interferential | Kotz
- max. 4 channels (8 electrodes)
- battery | mains operation
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The Genesy devices do not have as wide a range of programs and as many options for peripheral paralysis as PeroBravo. Doctors and therapists have designed the treatment programs, taking into account today’s medical recommendations.
The Genesy 600 has 1 treatment programme for severe, moderate and mild nerve damage, while the Genesy 1500 and 3000 have 3 to 3 treatment programmes. The latter devices allow the therapist to create his/her own denervated treatment programme, which takes into account the specific characteristics and treatment needs of the patient. This provides with a more tailor-made treatment from the therapist.
You can find the treatment programs in the Program list under Medical Treatments, specifically within the Denervated program group.
- A triangle pulse is used for cases of severe nerve damage.
- Triple pulse for partial damage, while
- A square pulse is used for cases of mild damage
Stimulation treatment of facial nerve paralysis
The facial nerve has three main branches that supply many muscles of the face. In the diagram below, you can see that there are about a dozen muscles in the forehead, around the eyes, around the mouth, in the jaw and in the cheek (cheekbone).
In each case, it may be different which branch, and within that which muscle, is most affected. Some people have problems in all three branches, others “only” in smaller areas.
Treatment should be based on where your symptoms are. Each muscle should receive individual treatment because the extent of damage may vary, and a distinct program may be necessary for each muscle.
Placement and use of electrotherapy devices
Use a small (about 25mm) round electrode for the treatment. Suitable ones are PALS Round 25mm or ValueTrode Round 32mm.
In the below figure, you can see several points.
Connect the negative pole of the cable (usually indicated in black) to the electrode glued near the tab. This electrode will always stay in place. Place the positive electrode (red terminal) on the first point (e.g.: the forehead).
After placing the electrodes, carry out the treatment. When it is finished, put the positive electrode on the next point (e.g.: close to the eye socket), the negative one stays at the ear. Again, repeate the treatment.
Go through all the necessary points one after the other.
In the treatment of facial paralysis (Bell’s palsy), the facial nerve needs to be treated at several points. Use a small (about 25mm), round electrode. Always stick the negative pole near the ear. The position of the positive pole should be varied. Start on the forehead, then when the treatment time is up, move the electrode and treat there too. It’s important to note that not all the points shown require treatment in every case. Be sure to consult your physiotherapist for guidance.
Apply the current carefully. Keep increasing until you feel the muscle contract. Then gradually increase the intensity, treatment by treatment, until you feel the facial muscles contract firmly but not painfully.
The facial muscles are very small, so you can feel the muscles twitch at 2-3 mA (very low) intensity.
If you also have sensory disturbance, be aware that since you can’t feel the pulse, you may be raising the amperage too high. Too high a current intensity can cause a burn-like injury to your skin.
How to make it more efficient!
To make the stimulator treatment more effective, combine it with mimic exercises in front of a mirror!
When you feel the pulse of the device and the muscle contraction while watching your face, voluntarily assist it! The visual stimuli will also transmit impulses from your brain’s visual field to the injured facial nerve. This combined treatment will greatly enhance the activity of healing-regenerative impulses, improving efficiency and speeding up the healing process.
Soft lasers, the supporting therapy for facial nerve paralysis
In addition, to the electrostimulation treatment, the soft laser treatment is an effective treatment for Bell’s palsy either as an alternative or as an additional treatment. Find a similar article regarding facial paralysis treatment with soft laser at home.
Source:
Aghamohamdi D, Fakhari S, Farhoudi M, Farzin H. The Efficacy of Low-Level Laser Therapy in the Treatment of Bell’s Palsy in Diabetic Patients. J Lasers Med Sci. 2020 Summer;11(3):310-315. doi: 10.34172/jlms.2020.52. Epub 2020 Jun 21. PMID: 32802293; PMCID: PMC7369545.
What outcome can you expect?
People with Bell’s Palsy often ask me, “I had Bell’s Palsy a year ago. I’ve had exercise, soft laser treatment, acupuncture, but unfortunately I don’t see much improvement. My left side of my mouth “hangs” like after a visit to the dentist. What do you think my prospects are?”
Well… The answer is in the category of “prediction”.
You can’t tell what the future holds through the internet, or even by meeting a patient in person.
The outcome and effect of medical treatments depends on several factors. To mention a few for example:
- When did the treatment begin after paralysis? Not much can be done if treatment starts months after the onset of paralysis. You need treatment (medication, soft laser, electrotherapy) on the day of paralysis.
- How long was the treatment session? The majority of patients think that 5-10 sessions of physiotherapy in a specialist clinic, the same amount of soft laser and electrotherapy are enough. Unfortunately, this is not the case. You need to be persistent and usually expect improvement after 3-6 months. For many people, treatment may even go beyond a year.
- Was the treatment effective? Treatment with the wrong device, lenght, at the wrong treatment points is pointless and ineffective.
Therefore, what, where and how you treat is very important.
Conclusion
Without treatment, a minority of cases cure Bell’s palsy on its own. The problem is that it is impossible to know in advance who will be so lucky.
Therefore, you have to treat it daily and persistently. For up to one and a half to two years. If there is no change after that time…. well… there are cases like that. In some cases even persistent treatment does not bring results, fortunately, this is a smaller group.
In summary, sticking to the recommended treatment schedule by exercising 4-5 times a day for 10-15 minutes, using electrotherapy at least once daily (multiple sessions are even better), and receiving soft laser treatments every day or every other day can give you reasons to be hopeful about improvement, even though a 100% guarantee is not certain.