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NEUROLOGY 2006;66:1907-1912
© 2006 American Academy of Neurology

The localization of facial motor impairment in sporadic Möbius syndrome

L. Cattaneo, MD, E. Chierici, MD, B. Bianchi, MD, E. Sesenna, MD and G. Pavesi, MD

From the Sezione di Neurologia (L.C., E.C., G.P.), Dipartimento di Neuroscienze, and Sezione di Chirurgia Maxillo Facciale (B.B., E.S.), Dipartimento di Scienze Otorino-Odonto-Oftalmologiche e Cervico facciali, Università degli Studi di Parma, Italy.

Address correspondence and reprint requests to Dr. L. Cattaneo, Sezione di Neurologia, Dipartimento di Neuroscienze, Università di Parma, Via Gramsci 14, 43100 Parma, Italy; e-mail: Luigi.cattaneo{at}nemo.unipr.it

Objective: To investigate the neurophysiologic aspects of facial motor control in patients with sporadic Möbius syndrome defined as nonprogressive congenital facial and abducens palsy.

Methods: The authors assessed 24 patients with sporadic Möbius syndrome by performing a complete clinical examination and neurophysiologic tests including facial nerve conduction studies, needle electromyography examination of facial muscles, and recording of the blink reflex and of the trigeminofacial inhibitory reflex.

Results: Two distinct groups of patients were identified according to neurophysiologic testing. The first group was characterized by increased facial distal motor latencies (DMLs) and poor recruitment of small and polyphasic motor unit action potentials (MUAPs). The second group was characterized by normal facial DMLs and neuropathic MUAPs. It is hypothesized that in the first group, the disorder is due to a rhombencephalic maldevelopment with selective sparing of small-size MUs, and in the second group, the disorder is related to an acquired nervous injury during intrauterine life, with subsequent neurogenic remodeling of MUs. The trigeminofacial reflexes showed that in most subjects of both groups, the functional impairment of facial movements was caused by a nuclear or peripheral site of lesion, with little evidence of brainstem interneuronal involvement.

Conclusion: Two different neurophysiologically defined phenotypes can be distinguished in sporadic Möbius syndrome, with different pathogenetic implications.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 27 issue to find the title link for this article.

Supported by the Italian Association for Möbius Syndrome "Associazione Italiana Sindrome di Moebius O.N.L.U.S."

Disclosure: The authors report no conflicts of interest.

Received August 31, 2005. Accepted in final form March 13, 2006.






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