Prognostic factors of Bell's palsy and Ramsay Hunt syndrome.

The aim of this study was to compare clinical characteristics, electroneurography (ENoG) results, and functional outcomes of patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS).Around 57 patients with BP and 23 patients with RHS were enrolled in this study from January 2010 and September 2015. Both clinical characteristics and ENoG results were recorded at hospital admission. The evaluations of functional outcomes were conducted with House-Brackmann (H-B) grading system at 6-month follow-up.There were no significant differences in age, gender proportion, initial H-B grades, time before commencement of treatment and the presence of comorbid disease in 2 groups. However, the final H-B grades at 6-month follow-up were significantly better in BP patients than RHS patients. The results of ENoG showed that degeneration index (DI) was significantly higher in the RHS group than the BP group. But no significant difference was found in the value of prolonged latency time (PLT) between the 2 groups. In multivariate analysis, age and ENoG DI were independently associated with functional outcome of recovery in the BP group (OR 0.167, 95% CI 0.038-0.622, P = 0.009 and OR 0.289 95% CI 0.107-0.998, P = 0.050, respectively). However, in the RHS group, only ENoG DI was related to the final H-B grades (OR 0.067, 95% CI 0.005-0.882, P = 0.040). Spearman's rank correlation analysis showed that higher age and ENoG DI were related to poorer prognosis in 2 groups (P < 0.05). PLT was related to functional outcomes only in the BP group (rs = 0.460, P < 0.001). The receiver operating characteristic (ROC) of ENoG DI analysis revealed that the cutoff value was 67.0% for BP prognosis and 64.5% for RHS prognosis. What's more, patients with hypertension or diabetes mellitus had both higher final H-B grade and ENoG DI than those without the same comorbidity.Patients with RHS had poorer prognosis than those with BP. Some factors including age, ENoG DI, and the presence of disease influenced recovery from BP and RHS. The present study demonstrated that BP patients with ENoG DI < 67.0% and RHS patients with ENoG DI < 65.5% had a greater opportunity for recovery within half a year.

Bulbocavernosus Reflex Test for Diagnosis of Pudendal Nerve Injury in Female Patients with Diabetic Neurogenic Bladder.

The study was designed to investigate the clinical application and significance of the bulbocavernosus reflex (BCR) test for diagnosing diabetic neurogenic bladder (DNB) in female subjects. In this study, 68 female patients with DNB and 40 female normal controls were subjected to a nerve conduction study (NCS) of all four limbs and the BCR test. The data were analyzed and compared, and the corresponding diagnostic sensitivities were discussed. Mean BCR latency for female DNB patients was significantly prolonged, compared to that of the control group, suggesting pudendal nerve injuries in female DNB patients. Moreover, DNB patients were categorized according to the diabetes course. Compared to that of Group A (diabetes course < 5 y), the mean BCR latency was significantly prolonged in Group B (diabetes course between 5 and 10 y) and then further prolonged in Group C (diabetes course > 10 y), which were all longer than the control group. Furthermore, compared with that of the controls, the mean BCR latency was prolonged in DNB patients with or without NCS abnormalities in limbs. Nevertheless, no significant difference was observed in BCR latency between DNB patients with and without NCS abnormalities. Significantly increasing trends were also observed in the NCS and BCR abnormality rates along with increased diabetes course. Most importantly, compared with the NCS of limbs, the BCR test was more sensitive in diagnosing DNB in the female subjects. Overall, our findings suggest that the BCR test would help to assess the pudendal nerve injury in female DNB patients, which might be a potential diagnostic tool in the clinic.

Bulbocavernosus reflex and pudendal nerve somatosensory evoked potential are valuable for the diagnosis of cauda equina syndrome in male patients.

AIMS: This study is to assess the value of bulbocavernosus reflex (BCR) and pudendal nerve somatosensory evoked potential (SSEP) in the topical diagnosis of cauda equina syndrome (CES) with or without sphincter dysfunction in male patients. METHODS: In this study, 40 healthy male adults (control group) and 53 male adult patients (experimental group) were included. The experimental group was subdivided into sphincter subgroup (24 patients with sphincter dysfunction) and non-sphincter subgroup (29 patients without sphincter dysfunction). All subjects underwent BCR and SSEP examinations. The mean latencies of BCR and SSEP P41 were calculated and compared between the control group and the experimental group. Latencies above the average value of +2.58S were considered abnormal. The abnormality rates of BCRs and SSEPs in sphincter and non-sphincter subgroups were calculated, respectively. RESULTS: BCR and SSEP latencies in the experimental group were remarkably prolonged than those in the control group. BCR and SSEP latencies in sphincter subgroup were remarkably prolonged than those in non-sphincter subgroup. Among the 106 nerves in the experimental group, 87 nerves had prolonged BCR latencies and 3 nerves had no wave elicited, with an abnormality rate of 84.9%. The abnormality rates of BCR were 95.8% and 74.1% in sphincter subgroup and non-sphincter subgroup, respectively. Among the 53 nerves in the experimental group, 39 nerves had prolonged SSEP P41 latencies and 2 nerves had no wave elicited, with an abnormality rate of 77.4%. The abnormality rates of SSEP P41 were 91.7% and 65.5% in sphincter subgroup and non-sphincter subgroup, respectively. CONCLUSIONS: Both BCR and SSEP were changed in CES patients with or without sphincter dysfunction, and they were especially changed in patients with sphincter dysfunction. BCR and SSEP are valuable in the diagnosis of cauda equina lesions and their severity in males.

Bulbocavernosus reflex and pudendal nerve somatosensory-evoked potentials responses in female patients with nerve system diseases.

To assess the value of bulbocavernosus reflex (BCR) and pudendal nerve somatosensory-evoked potential (SSEP) in the topical diagnosis of central and peripheral nervous system diseases in female patients. Neuroelectrophysiologic technique was adopted to determine both BCR and SSEP of 41 healthy adult females (control group), 30 female patients with spinal cord lesions (central group), and 50 female patients with peripheral nerve lesions (peripheral group), including nine female patients with acute cauda equina syndrome. The abnormality rates of BCR were 8.33% and 70.00% in the central group and the peripheral group, respectively, and there were statistical differences between the two groups. The abnormality rates of BCR were 72.22% in the patients with acute cauda equina syndrome abnormal, who have at least one side of the abnormal BCR. The abnormality rates of SSEP P41 were 86.67% and 82.00% in the control and peripheral groups, respectively, and there were no statistical differences between the two groups. The abnormality rates of SSEP P41 were 88.89% in the patients with acute cauda equina syndrome abnormal. Also, there were no statistical differences between the peripheral group and the patients with acute cauda equina syndrome in the abnormality rates of SSEP or BCR. Both BCR and SSEP changed in the peripheral group, especially in the patients with acute cauda equina syndrome, but only SSEP changed in the central group. BCR and SSEP are valuable in the topical diagnosis of nervous system diseases in females.