Investigation of functional connectivity in Bell?s palsy using functional magnetic resonance imaging: prospective cross- sectional study

Background: The most common cause of lower motor neuron facial palsy is Bell's palsy (BP). BP results in partial or complete inability to automatically move the facial muscles on the affected side and, in some cases, to close the eyelids, which can cause permanent eye damage. This study investigated changes in brain function and connectivity abnormalities in patients with BP.Methods: This study included 46 patients with unilateral BP and 34 healthy controls (HCs). Resting-state brain functional magnetic resonance imaging (fMRI) images were acquired, and Toronto Facial Grading System (TFGS) scores were obtained for all participants. The fractional amplitude of low-frequency fluctuation (fALFF) was estimated, and the relationship between the TFGS and fALFF was determined using correlation analysis for brain regions with changes in fALFF in those with BP versus HCs. Brain regions associated with TFGS were used as seeds for further functional connectivity (FC) analysis; relationships between FC values of abnormal areas and TFGS scores were also analyzed.Results: Activation of the right precuneus, right angular gyrus, left supramarginal gyrus, and left middle occipital gyrus was significantly decreased in the BP group. fALFF was significantly higher in the right thalamus, vermis, and cerebellum of the BP group compared with that in the HC group (P<0.05). The FC between the left middle occipital gyrus and right angular gyrus, left precuneus, and right middle frontal gyrus increased sharply, but decreased in the left angular gyrus, left posterior cingulate gyrus, left middle frontal gyrus, inferior cerebellum, and left middle temporal gyrus. Furthermore, the fALFF in the left middle occipital gyrus was negatively correlated with TFGS score (R=0.144; P=0.008).Conclusions: The pathogenesis of BP is closely related to functional reorganization of the cerebral cortex. Patients with BP have altered fALFF activity in cortical regions associated with facial motion feedback monitoring.