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We hypothesized that FS involves the entire network of facial muscles on both sides of the face. Bilateral facial high-resolution surface electromyography (HR-sEMG), using a total of 58 electrodes, was performed during 11 standardized facial movements in 36 healthy adult participants (53% female, 18\u201367 years) and 36 patients with FS (81% female, 24\u201370 years). Differences between the synkinetic and contralateral sides of patients and healthy controls were evaluated using linear mixed-effects models. Each movement task elicited a complex activation pattern involving nearly all measured facial muscles. In healthy controls, HR-sEMG activity was highest in the muscles primarily responsible for generating the intended voluntary movement. Notably, in patients with FS, muscles not normally expected to be strongly involved in a given movement showed markedly higher activity on the synkinetic side, and often also on the contralateral side, compared with healthy controls. Thus, facial movements in FS evoke a complex pattern of activity that only partially serves the intended movement and is further characterized by involuntary activation in muscles outside the primary movement region and on the contralateral side.<\/jats:p>","DOI":"10.1038\/s41598-026-36015-1","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T08:45:06Z","timestamp":1768380306000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bilateral muscle activation in postparalytic facial synkinesis: a cross-sectional high-resolution surface electromyography study"],"prefix":"10.1038","volume":"16","author":[{"given":"Paul F.","family":"Funk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren","family":"Schramm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd Fabian","family":"Volk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Anders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-0784","authenticated-orcid":false,"given":"Orlando","family":"Guntinas-Lichius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"36015_CR1","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s40136-018-0200-x","volume":"6","author":"NA Krane","year":"2018","unstructured":"Krane, N. 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