[Hemifacial spasm: over 10 years of treatment with Botulinum toxin.]

Rev Neurol. 2007 Nov 16-30;45(10):582-6

Authors: Perez-Saldana MT, Parkhutik V, Bosca-Blasco ME, Claramonte B, Burguera-Hernandez JA

INTRODUCTION. The short-term beneficial and adverse effects of treatment with botulinum toxin (BT) in hemifacial spasm (HS) are well documented, but this is not the case with its long-term derivatives. AIMS. To describe the characteristics, the dose development, the side effects and the reason for giving up therapy in patients who have been on BT treatment for more than 10 years. We also sought to evaluate the effectiveness and safety of prolonged treatment in patients with HS. PATIENTS AND METHODS. We reviewed the demographic and clinical characteristics of patients who had had HS for more than 10 years since follow-up began. We analysed the mean dose development of BT per visit and year, the number of sessions per year, side effects and reasons for dropping out. We focused our attention on cases with more than 10 years' continuous treatment. RESULTS. The percentage of patients who had been on treatment for over ten years was 53.7%. The mean dose of BT per year rose progressively, and was significant (p < 0.05) during the first four years of treatment. There was no significant increase in the number of sessions. Altogether 46 side effects were observed, ptosis being the most frequent. These occurred during the first years of the early stages of the technique. The most common cause of dropout was loss to follow-up in 22 patients, followed by death in 11 cases. CONCLUSIONS. BT is a feasible, safe treatment option (with very few benign side effects) in the prolonged treatment of patients with HS.

PMID: 18008262 [PubMed - in process]

Hemifacial spasm in a patient with neurofibromatosis and Arnold-Chiari malformation: a unique case association.

Arq Neuropsiquiatr. 2007 Sep;65(3B):855-7

Authors: Fel&#xED;cio AC, Godeiro-Junior Cde O, Borges V, Silva SM, Ferraz HB

BACKGROUND: The association of hemifacial spasm (HFS), Chiari type I malformation (CIM) and neurofibromatosis type 1 (NF1) has not been described yet. CASE REPORT: We report the case of a 31-year-old woman with NF1 who developed a right-sided HFS. On magnetic resonance imaging (MRI) a CIM was seen without syringomyelia. The patient has been successfully treated with botulinum toxin type A injections for 5 years without major side effects. CONCLUSION:Clinical features of HFS, CMI and NF1 are highlighted together with their possible relationship. Also, therapeutic strategies are also discussed.

PMID: 17952297 [PubMed - in process]

Clinical assessment of patients with primary and postparalytic hemifacial spasm: a retrospective study.

Arq Neuropsiquiatr. 2007 Sep;65(3B):783-6

Authors: Felicio AC, Godeiro-Junior Cde O, Borges V, Silva SM, Ferraz HB

OBJECTIVE: To compared the clinical features of 373 patients with primary and postparalytic hemifacial spasm (HFS). METHOD: Data analyzed were gender, ethnicity, age at symptom onset, disease duration, affected side, distribution of facial spasm at onset, hypertension, family history of HFS, previous history of facial palsy and latency between facial palsy and HFS. RESULTS:The prevalence of patients with Asian origin was similar in both groups such as female/male ratio, mean age at symptom onset, disease duration, affected side and distribution at onset of facial twitching. The upper left side of the face was the main affected region at onset. Almost 40% of the patients in both groups had hypertension. A prevalence of vascular abnormalities on the posterior fossa was seen in 7% and 12.5% of both groups. CONCLUSION: The clinical profile and radiological findings of patients with primary and postparalytic HFS are similar. The association of hypertension with vascular abnormalities and HFS was not frequent.

PMID: 17952280 [PubMed - in process]

Hemifacial seizures and cerebellar tumor: a rare co-existence.

Indian Pediatr. 2007 May;44(5):378-9

Authors: Kulkarni S, Hegde A, Shah KN

We report a 4-year-old boy with multiple daily episodes of abnormal eye movements, hemifacial spasms. Neuro-imaging revealed a cerebellar tumor. We believe that this association constitutes a rare but important syndrome of epilepsy characterized by seizures of cerebellar origin.

PMID: 17536142 [PubMed - indexed for MEDLINE]

Delayed hemorrhage following microvascular decompression. Three case reports.

Neurol Med Chir (Tokyo). 2007 Apr;47(4):186-8

Authors: Li N, Zhao W, Pu C, Shen J

Postoperative hemorrhage is one of the most dangerous complications following microvascular decompression (MVD), and usually occurs within the first 24 hours after MVD operation, whereas delayed hemorrhage is extremely rare. The possible mechanisms of acute and delayed postoperative hemorrhage following MVD seem to be different. Three of 685 patients treated by MVD developed delayed hematoma more than 24 hours after surgery, including two cases at the operative site and one at a remote site. The possible causes of such delayed hemorrhage are discussed. Postoperative monitoring is extremely important after the MVD procedure. If any hemorrhage can be identified at the early stage, valuable time can be won for treatment and better outcome.

PMID: 17457025 [PubMed - indexed for MEDLINE]

[Costs and efficacy of type A botulinum toxin for the treatment of essential blepharospasm and hemifacial spasm]

Arq Bras Oftalmol. 2006 Sep-Oct;69(5):701-5

Authors: Lasalvia CG, Pereira Lde S, da Cunha MC, Kitadai SP

PURPOSE: To evaluate the costs and efficacy of type A botulinum toxin in the treatment of essential blepharospasm and hemifacial spasm. METHODS: Pacients with essential blepharospasm and hemifacial spasm had their files analyzed. All patients were treated with type A botulinum toxin (Dysport) between April 2002 and May 2004 at the Oculoplastic Clinics of "Santa Casa de S&#xE3;o Paulo". Twenty-seven patients presented essential blepharospasm and 23 presented hemifacial spasm. Information about the patient's degree of satisfaction after treatment, complaints and personal costs were recorded by a questionnaire, and information about the costs of Dysport treatment were obtained at the administration department of "Santa Casa de São Paulo". Wilcoxon and Mann-Whitney tests were used for statistical analysis. RESULTS: 1- The annual treatment costs were R Dollars 1,239.32 for essential blepharospasm and R Dollars 661.72 for hemifacial spasm. 2- The patient's annual costs were R Dollars 145.48 for essential blepharospasm and R Dollars 6.07 for hemifacial spasm. 3- The hospital's annual costs for the treatment were R Dollars 1,095.84 for essential blepharospasm and R Dollars 535.65 for hemifacial spasm. 4- Dysport treatment is successful in both essential blepharospasm and hemifacial spasm. CONCLUSIONS: The costs of essential blepharospasm and hemifacial spasm treatment with Dysport are high, mainly because of the toxin price. On economic analysis of health, we can conclude that this procedure has an excellent cost-benefit ratio.

PMID: 17187139 [PubMed - indexed for MEDLINE]

Anterior transpetrosal approach to the prepontine epidermoids.

Skull Base Surg. 1999;9(2):75-80

Authors: Shimamoto Y, Kawase T, Sasaki H, Shiobara R, Yamada F

We have operated on nine patients with a prepontine epidermoid extending to the bilateral cistern or the unilateral middle fossa using the anterior transpetrosal approach since 1986. The preoperative symptoms were unilateral trigeminal neuralgia, hearing disturbance, gait disturbance, double vision, facial hypesthesia, hemifacial spasm, and dysphagia. The most common neurological sign was unilateral trigeminal nerve disturbance. In two patients with useful hearing preoperatively lost, the labyrinth and mastoid air cells as well as the petrous apex were resected to extend the surgical field. Tumors were totally removed, except for capsules that were tightly adhered to the brain stem, cranial nerve, and vessels. The trigeminal neuralgia, hemifacial spasm, and dysphagia disappeared, but double vision improved only one out of three cases, and facial hypesthesia was unchanged in all cases. There were no postoperative deaths. New abducens palsy appeared in four cases and cerebrospinal fluid (CSF) leakage appeared in three cases postoperatively, but later these symptoms disappeared. In one case, postoperative chemical meningitis developed, and a ventricular shunt was required later to treat hydrocephalus. Postoperative follow-up, an average of 5,7 years, did not show any increases in any of the tumors. Based on our experience, we conclude that the anterior transpetrosal approach is more useful than the retromastoid suboccipital approach to resect the epidermoid located mainly in the prepontine cistern.

PMID: 17171121 [PubMed - in process]

Hemifacial spasm due to a large distant ipsilateral posterior fossa meningioma.

Skull Base Surg. 2000;10(1):43-5

Authors: Harrison GS, Chovan P, Lee JH

A rare case of hemifacial spasm due to an ipsilateral foramen magnum/clival meningioma is described. Magnetic resonance imaging demonstrated that the tumor was located distant to the cranial nerve VII/VIII complex. Resolution of the ipsilateral hemifacial spasm was noted after complete resection of the tumor. The mechanism of hemifacial spasm was likely due to displacement and distortion of the brain stem from the lesion distant to the cranial nerve VII/VIII complex. In our review of the literature this is the first reported case of an ipsilateral posterior fossa meningioma causing hemifacial spasm from indirect mass effect.

PMID: 17171100 [PubMed - in process]

Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm.

Skull Base. 2001 Aug;11(3):189-97

Authors: Eby JB, Cha ST, Shahinian HK

Hemifacial spasm is an uncommon disorder manifesting as a unilateral, involuntary, sporadic contraction of the musculature innervated by the seventh cranial nerve. Although debated, the etiology of hemifacial spasm is generally accepted as compression of the facial nerve by vessels of the posterior circulation. Early surgical techniques were ineffective and fraught with morbidity. Over the past 25 years microvascular decompression surgery has allowed the safe and effective treatment of hemifacial spasm. Recent reports combining microsurgical and endoscopic techniques have documented the advantages of the endoscope in exposing the anatomy of this region. Enhanced visualization allows a less traumatic dissection and increases the surgeon's ability to locate nerve-vessel conflicts often difficult to identify through the limited view of the microscope. This article reviews the history of hemifacial spasm and describes the first three cases of fully endoscopic vascular decompression for hemifacial spasm, emphasizing the advantages of this novel surgical approach.

PMID: 17167620 [PubMed - in process]

[Lacrimal film evaluation of patients with facial dystonia during botulinum toxin type A treatment]

Arq Bras Oftalmol. 2006 May-Jun;69(3):319-22

Authors: Costa PG, Cardoso IP, Saraiva FP, Raiza AC, Tanaka LK, Matayoshi S

PURPOSE: To determine the effect of botulinum toxin injection in the eyelid on lacrimal film in patients with facial dystonia. METHODS: Twenty-four patients with essential blepharospasm and hemifacial spasm were submitted to botulinum toxin injection and lacrimal film tests were performed before the application and after seven and thirty days. RESULTS: There was improvement in symptoms of dry eye and rose bengal test, however, the breakup time and Schirmer's test did not show significant variation between pretreatment and after 1 month of follow-up. CONCLUSION: The dry eye symptoms in patients with facial dystonia may be attenuated by botulinum toxin due to its possible inhibitory effect on the orbicular muscle leading to a decrease in lacrimal pump.

PMID: 16936952 [PubMed - indexed for MEDLINE]

[Painful tic convulsif and Botulinum toxin]

Rev Neurol. 2006 Jun 16-30;42(12):729-32

Authors: Bosc&#xE1;-Blasco ME, Burguera-Hernández JA, Roig-Morata S, Martínez-Torres I

INTRODUCTION: Painful tic convulsif is a rare disorder that associates trigeminal neuralgia (TN) and ipsilateral hemifacial spasm (HFS). These two disorders are the most common examples of hyperactive cranial rhizopathy and are frequently caused by vascular compression of these cranial nerves at the nerve root entry and exit zone in the brain stem, which leads to paroxysmal ephaptic transmission. CASE REPORTS: We report the cases of four patients with combined TN and HFS out of a total of 247 patients with HFS who were treated with botulinum toxin. One patient had TN that was contralateral to the HFS, while the other three were ipsilateral, and one of these had bilateral HFS. In all four cases both the HFS and the TN improved with botulinum toxin treatment. CONCLUSIONS: These four patients with TN and HFS suggest a common aetiology for the two disorders, due either to central neuronal hyperactivity or to vascular compression of several cranial nerves. The beneficial effect of botulinum toxin in both disorders supports the idea of this toxin having a central mechanism of action that acts by controlling neuronal hyperactivity in the brain stem, as well as its peripheral action.

PMID: 16775798 [PubMed - indexed for MEDLINE]

A comparative study of primary and secondary hemifacial spasm.

Arch Neurol. 2006 Mar;63(3):441-4

Authors: Colosimo C, Bologna M, Lamberti S, Avanzino L, Avanzino L, Marinelli L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A

BACKGROUND: Hemifacial spasm (HFS) is a common movement disorder. OBJECTIVE: To evaluate possible differences in the demographic and clinical features between primary and secondary HFS. DESIGN: In-person interview using a standardized questionnaire to collect demographic and clinical data. SETTING: A multicenter study that included patients with HFS attending 3 Italian academic centers.Patients Two hundred fourteen patients with HFS. MAIN OUTCOME MEASURE: A complete neurological examination assessed the current muscle distribution of spasm and the presence of synkinetic movements between upper and lower facial muscles. RESULTS: The study sample comprised 214 patients with HFS, 81 men and 133 women, having a mean +/- SD age of 65.9 +/- 12.3 years; 164 patients were classified as having primary HFS and 50 patients (48 postparalytic and 2 symptomatic cases) were classified as having secondary HFS. Patients with primary and those with secondary HFS had similar mean +/- SD ages at onset (54.9 +/- 13.5 vs 57.0 +/- 12.8 years), male-female ratios (63:101 vs 18:32), right-sided-left-sided HFS (77:86 [1 bilateral] vs 21:28 [1 bilateral]), and frequencies of familial cases (2.9% vs 2.0%), respectively. Most patients (65.0%) with primary HFS had initial symptoms of periocular muscle contractions alone and had subsequent involvement of the lower facial muscles. Most patients (72.0%) with secondary HFS reported initial involvement of the upper and lower facial muscles simultaneously. Signs of synkinesis were present in primary (43.3%) and secondary (58.0%) HFS. CONCLUSIONS: Patients with primary and those with secondary HFS share common demographic and clinical features, including sex distribution, age at onset, affected side of HFS, synkinesis, and rarity of familial cases. Signs of synkinesis were present in significant proportions of patients with primary or secondary HFS. The 2 forms differed in clinical presentation.

PMID: 16533973 [PubMed - indexed for MEDLINE]

[Essential blepharospasm and hemifacial spasm: characteristic of the patient, botulinum toxin A treatment and literature review]

Arq Bras Oftalmol. 2006 Jan-Feb;69(1):23-6

Authors: Schellini SA, Matai O, Igami TZ, Padovani CR, Padovani CP

PURPOSE: To evaluate the characteristics of the essential blepharospasm and hemifacial spasm patients and the feasible treatment with botulinum toxin A. METHODS: Thirty-four essential blepharospasm or hemifacial spasm patients were evaluated according to gender, ocular complaint, time of disease, treatment outcome and complications. RESULTS: Age median was 63 years and the mean was 61 years, with no difference regarding sex; 66.66% of the patients had hemifacial spasm and 33.33%, essential blepharospasm. Many patients complained of dry eye associated with involuntary spasm. Botulinum toxin A showed a positive outcome in 91.30% of the treated patients and complications observed after treatment were eyelid ptosis (8.33%) and buccal angle deviation (8.33%). CONCLUSION: Essential blepharospasm and hemifacial spasm occurred in the elderly, of both sexes. Treatment with botulinum toxin A was useful, with very low complication rates.

PMID: 16491229 [PubMed - indexed for MEDLINE]

The changes in corneal astigmatism after botulinum toxin-a injection in patients with blepharospasm.

J Korean Med Sci. 2006 Feb;21(1):131-5

Authors: Moon NJ, Lee HI, Kim JC

To determine if the involuntary contractions of eyelids may have any effects on the development of corneal astigmatism, we performed this prospective study which includes 19 patients with either essential blepharospasm or hemifacial spasm. In hemifacial spasm, the degree of corneal astigmatism was evaluated between two eyes. Then the topographic changes were checked using vector analysis technique before and after passively opening the eyelids. They were also measured before and at 1 and 6 months after the injection of Botulinum toxin. Resultantly, 20 eyes had the with-the-rule (group1) and 9 eyes against-the-rule (group2) astigmatism. In hemifacial spasm, significantly more astigmatism was found at spastic eyes. The corneal topographic changes after passively opening the eyelids showed 10 eyes with the astigmatic shift to the with-the-rule, while the remaining 19 to the against the- rule. At 1 month after injection of Botulinum toxin, group 1 showed reduced average corneal astigmatism, whereas group 2 showed increased astigmatism. The astigmatic change vector showed significantly more against-the-rule. In the contrary, 6 months after treatment, corneal astigmatism again increased in group 1 and decreased in group 2. So they took on the appearance of pretreatment astigmatic status eventually. Conclusively eyelids may play an important role in corneal curvature.

PMID: 16479079 [PubMed - indexed for MEDLINE]

Abnormal muscle responses in hemifacial spasm: F waves or trigeminal reflexes?

J Neurol Neurosurg Psychiatry. 2006 Feb;77(2):216-8

Authors: Misawa S, Kuwabara S, Ogawara K, Hattori T

OBJECTIVE: In patients with hemifacial spasm (HFS), abnormal muscle responses (AMR) are frequently present. The objective of this study was to investigate whether the afferent input of AMR is mediated by antidromic facial nerve stimulation or orthodromic trigeminal nerve stimulation. METHODS: AMR in the orbicularis oris muscle were recorded in 28 patients with HFS. When AMR were present, they were recorded after subthreshold stimulation of the facial nerve and weak stimulation delivered to the skin. RESULTS: AMR were recordable in 24 (86%) of the patients, and usually consisted of the early constant component (mean onset latency, 10.0 ms) and late variable component (35.3 ms), similar to R1 and R2 of the blink reflex. The early or late components of AMR, or both, were frequently elicited after subthreshold stimulation of the facial nerve (43%) and skin stimulation (88%). CONCLUSIONS: AMR are likely to be mediated by trigeminal afferent inputs, rather than antidromic activation of the facial nerve, and are a type of trigeminal reflex.

PMID: 16421125 [PubMed - indexed for MEDLINE]

Health-related quality of life and psychosocial characteristics of patients with benign essential blepharospasm.

Arch Ophthalmol. 2006 Jan;124(1):116-9

Authors: Hall TA, McGwin G, Searcey K, Xie A, Hupp SL, Owsley C, Kline LB

OBJECTIVE: To examine vision-targeted health-related quality of life and psychosocial characteristics in patients with benign essential blepharospasm (BEB) compared with patients with hemifacial spasm (HFS). METHODS: Persons with BEB (n = 159) or HFS (n = 91) were identified based on International Classification of Diseases, Ninth Revision, Clinical Modifications codes with subsequent verification by record abstraction. Information regarding demographics, health characteristics, disease characteristics, and vision-targeted health-related quality of life was obtained through a telephone interview. RESULTS: For patients with BEB and HFS, the composite scores and subscale scores on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) were low. Compared with patients with HFS, patients with BEB reported more depressive symptoms (P = .03), met the criteria for generalized anxiety disorder (P = .007), had lower NEI-VFQ-25 composite scores (P<.001), and had lower NEI-VFQ-25 subscale scores regarding general vision (P = .03), ocular pain (P<.001), distance activities (P = .001), driving (P<.001), and all of the vision-specific subscales addressing psychosocial issues. CONCLUSIONS: Compared with patients with HFS, those with BEB experience a greater reduction in vision-targeted health-related quality of life and are more prone to symptoms of depression and anxiety. This underscores the inadequacy of current treatment options for BEB in light of the fact that these patients had been undergoing standard-of-care treatments for some time.

PMID: 16401794 [PubMed - indexed for MEDLINE]

Asymmetry of blinking.

Invest Ophthalmol Vis Sci. 2006 Jan;47(1):195-201

Authors: Kassem IS, Evinger C

PURPOSE: Too investigate asymmetry in eyelid movements with blinking, the stability of the asymmetry, and its modifiability in normal humans. METHODS: Differences in the start time and amplitude between the two eyelids were assessed for voluntary blinks and reflex blinks evoked by supraorbital trigeminal nerve stimulation. These variables were also measured before and up to 18 months after 2 hours of unilateral upper lid restraint. RESULTS: With voluntary blinks, one eyelid consistently began to close earlier and made a larger eyelid movement than the other eyelid. Stimulation of the supraorbital branch of the trigeminal nerve evoked relatively larger amplitude blinks in one eyelid that correlated with the asymmetries of voluntary blinks. There was a continuum of eyelid asymmetry across all subjects that was stable and independent of other biological asymmetries, such as handedness. Briefly reducing eyelid mobility created a long-lasting change in eyelid asymmetry with blinking. CONCLUSIONS: Eyelid asymmetry results from differences in the excitability of motoneurons in the left and right facial motor nuclei and does not appear to involve asymmetries in cortical inputs to the brain stem. Because adaptive processes modify the motoneuron excitability that creates eyelid asymmetry, these processes may underlie changes in blinking associated with facial palsy and may play a role in the development of disorders that affect one side of the face, such as hemifacial spasm.

PMID: 16384962 [PubMed - indexed for MEDLINE]

Hemifacial motor and crying seizures of temporal lobe onset: case report and review of electro-clinical localisation.

J Neurol Neurosurg Psychiatry. 2006 Jan;77(1):107-10

Authors: Hogan RE, Rao VK

OBJECTIVE: To report a case of temporal lobe epilepsy with clinical presentation of paroxysmal episodes of "tightness" over the right hemiface, and ictal crying, and review electroclinical localisation of this phenomenon. METHODS: Clinical semiology, neurophysiological localising tests, and epilepsy surgery outcome are reported in a subject presenting with paroxysmal right hemifacial movements and ictal crying. Pertinent past reports of somato-motor signs and ictal crying in temporal lobe epilepsy are reviewed and the findings correlated with proposed human facial cortical representation. RESULTS: Simple partial seizures caused by temporal lobe epilepsy presented with right sided tonic facial movements and ictal crying. Intracranial EEG monitoring documented a left medial temporal onset of seizures that remained asymptomatic until they propagated to the left cingulate region. Anterior temporal lobectomy with resection of the amygdala and anterior hippocampus resulted in cessation of seizures. CONCLUSIONS: This is a rare example of epileptic seizures of medial temporal onset presenting with isolated somato-motor manifestations and ictal crying. Anatomical-electrical-clinical correlations with cortical regions controlling facial movements were highly suggestive that this case represents secondary activation of "emotional" motor cortex M3 and M4 (rostral and caudal cingulate motor cortex), giving rise to focal hemifacial movements and ictal crying.

PMID: 16361607 [PubMed - indexed for MEDLINE]

[Botulinum toxin in the treatment of facial dystonia: evaluation of its efficacy and patients' satisfaction along the treatment]

Arq Bras Oftalmol. 2005 Jul-Aug;68(4):471-4

Authors: Costa PG, Aoki L, Saraiva FP, Matayoshi S

PURPOSE: To study the efficiency of botulinum toxin treatment in facial dystonia patients and their satisfaction along treatment. METHODS: Retrospective study of 42 facial dystonia cases followed at the Oculoplastic Surgery Department of the "Hospital das Cl&#xED;nicas" of the University of São Paulo. RESULTS: Following the first injections, 45.2% of the patients scored the improvement of the spasms between 9-10, 35.7% scored between 7-8, 16.7% between 5-6 and only one patient scored the improvement of the spasm as 4. According to the remission time of the symptoms, 4.8% of the patients reported between 5-6 months, 64.2% between 3-4 months and 31% reported the need for a new injection after 1-2 months of the previous injection. During treatment, 76.1% of the patients maintained the same score for spasm improvement after the botulinum toxin injection, 19.1% reported improvement and only 4.8% noted worsening of efficiency of the last injections. Along the follow-up, 64.2% reported no change in the time of return of the symptoms, 16.7% had increased and 19.1% had decreased remission time of the symptoms. After injections, 19% of the patients presented side effects and 73.8% of the patients complained of mild to moderate discomfort during the injection. CONCLUSIONS: Botulinum toxin was efficient and no change of efficiency along the time was observed. Side effects are few and the tolerance to injections are good. It is a good alternative in order to improve quality of life of these patients avoiding functional blindness caused by these diseases.

PMID: 16322831 [PubMed - indexed for MEDLINE]

Validation of a short disease specific quality of life scale for hemifacial spasm: correlation with SF-36.

J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1707-10

Authors: Tan EK, Fook-Chong S, Lum SY, Thumboo J

BACKGROUND: A short, practical, and validated quality of life (QoL) scale for hemifacial spasm (HFS) is not currently available. OBJECTIVES: To examine the reliability and validity of a short self-rating scale (HFS-7) by comparing HFS patients with healthy controls. We also evaluated the correlation of HFS-7 with the physical and mental domains of SF-36, a generic QoL scale. METHODS: Seven self-rating items (HFS-7) were administered to HFS patients and healthy controls. In addition, HFS patients answered the SF-36 questionnaire. The validity and reliability of HFS-7 were analysed and correlation between HFS-7 and SF-36 examined. RESULTS: A total of 178 subjects were enrolled in the study, including 85 HFS patients with mean age of 54.8 (SD 11.0) years, of whom 52 (61.2%) were women, and 93 controls with mean age of 51.4 (SD 10.0) years, of whom 59 (63.4%) were women. The test-retest intraclass correlation coefficient for the seven items was between 0.75 and 0.90 and Cronbach's coefficient of reliability for the HFS-7 scale was 0.88. Every item in HFS-7 discriminated between disease and controls (p<0.0001). The HFS-7 summary index correlated with the SF-36 summary score (Spearman's correlation r = -0.28, p = 0.009), in particular the mental health summary score (r = -0.416, p<0.0001) and the emotional domain (r = -0.466, p<0.00001). CONCLUSION: HFS-7 could prove useful as a simple clinical tool to assess and monitor QoL measures in HFS patients.

PMID: 16291898 [PubMed - indexed for MEDLINE]

Repeat microvascular decompression for hemifacial spasm.

J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1574-80

Authors: Engh JA, Horowitz M, Burkhart L, Chang YF, Kassam A

OBJECTIVE: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. METHODS: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations. RESULTS: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03). CONCLUSIONS: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.

PMID: 16227555 [PubMed - indexed for MEDLINE]

Neurological picture. Hemifacial spasm, neuralgia, and syncope due to cranial nerve compression in a patient with vertebral artery ectasia.

J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1500

Authors: Spengos K, Tsivgoulis G, Stouraitis G, Vassilopoulos D, Toulas P, Gialafos E

PMID: 16227538 [PubMed - indexed for MEDLINE]

Virtual endoscopic images by 3D FASE cisternography for neurovascular compression.

Magn Reson Med Sci. 2003 Oct 1;2(3):145-9

Authors: Ishimori T, Nakano S, Kagawa M, Yokoe K, Togami T, Asakura H, Kusuhara T, Ohkawa M, Nagao S, Yamashita Y, Sugiura S

Three-dimensional fast asymmetric spin echo (3D FASE) cisternography provides high spatial resolution and excellent contrast as a water image acquisition technique. It is also useful for the evaluation of various anatomical regions. This study investigated the usefulness and limitations of virtual endoscopic images obtained by 3D FASE MR cisternography in the preoperative evaluation of patients with neurovascular compression. The study included 12 patients with neurovascular compression: 10 with hemifacial spasm and two with trigeminal neuralgia. The diagnosis was surgically confirmed in all patients. The virtual endoscopic images obtained were judged to be of acceptable quality for interpretation in all cases. The areas of compression identified in preoperative diagnosis with virtual endoscopic images showed good agreement with those observed from surgery, except in one case in which the common trunk of the anterior inferior cerebellar artery and posterior inferior cerebellar artery (AICA-PICA) bifurcated near the root exit zone of the facial nerve. The veins are displayed in some cases but not in others. The main advantage of generating virtual endoscopic images is that such images can be used for surgical simulation, allowing the neurosurgeon to perform surgical procedures with greater confidence.

PMID: 16222106 [PubMed - indexed for MEDLINE]

[Neurological manifestations of dengue: study of 41 cases.]

Arq Neuropsiquiatr. 2005 Jun;63(2B):488-93

Authors: Ferreira ML, Cavalcanti CG, Coelho CA, Mesquita SD

The increase of encephalitis and meningoencephalitis in patients with dengue, diagnosed at a public hospital, Neurology State reference, we adopted systematic data collection. OBJECTIVE: The objective was to present 41 cases of neurological manifestations of dengue and to compare data with literature. METHOD: This is a descriptive study, retrospective from March to July 1997 and, prospective, from February to May 2002, analyzing damaged neurological regions and diagnostic of 41 patients. RESULTS: Involved regions were brain (5/7 cases - 71.4%, in 1997, and 20/34 cases - 58.8%, in 2002), spinal cord (2/34 cases - 5.9% in 2002) and peripheral nerves (2/7 cases - 28.6% in 1997 and 12/34 cases - 35.3% in 2002). There was no meningeal involvement. According to topography, there was encephalic and peripheral nerves diagnosis in both periods and, exclusively in 2002, spinal cord damage. Cerebral hemorrhage and acute disseminated encephalomyelitis were diagnosed for the first time, as well as hemifacial spasm worsening as possible neurological manifestation of dengue. CONCLUSION: This is the third casuistics in dengue and nervous system. Three dengue complications were diagnosed, for the first time registered on the literature.

PMID: 16059604 [PubMed - indexed for MEDLINE]

Endovascular treatment of vertebral artery aneurysm manifesting as progressive hemifacial spasm.

Neurol Med Chir (Tokyo). 2005 Jul;45(7):360-2

Authors: Matsumoto K, Kimura S, Kakita K

A 62-year-old woman presented with right hemifacial spasm persisting for 6 months. Brain magnetic resonance imaging and digital subtraction angiography showed a wide-neck aneurysm of the intracranial portion of the right vertebral artery. The patient underwent endovascular trapping of the aneurysm by coil embolization of the parent vessel on both sides of the aneurysm. The patient experienced gradual disappearance of the hemifacial spasm within 3 months. No relapses occurred during a follow-up period of 3 years. Magnetic resonance imaging revealed shrinkage of the vertebral artery aneurysm which had compressed the facial nerve. Endovascular trapping of a vertebral artery aneurysm can be used to treat hemifacial spasm caused by an aneurysm instead of surgical microvascular decompression.

PMID: 16041182 [PubMed - indexed for MEDLINE]

Microvascular decompression in patients with hemifacial spasm: report of 1200 cases.

Chin Med J (Engl). 2005 May 20;118(10):833-6

Authors: Yuan Y, Wang Y, Zhang SX, Zhang L, Li R, Guo J

BACKGROUND: Microvascular Decompression (MVD) operation is the most reliable treatment for hemifacial spasm (HFS), but it causes many complications. The aim of this retrospective study was to investigate the factors relavent to the effects and postoperative complications of microvascular decompression on hemifacial spasm. METHODS: A total of 1200 HFS patients treated with MVD were studied retrospectively. The root exit zone (REZ) of the facial nerve was exposed through the infraflocculus approach, the offending vessels were identified and separated from the REZ, and a Teflon graft was interposed between the offending vessels and the brain stem. Brain stem auditory evoked potential (AEP) was monitored intraoperatively. RESULTS: The offending vessels can be identified in all patients. The anteroinferior cerebellar artery was the main offending vessel (42.6%). Patients with vertebral artery compression had a multiple vascular compression fashion. Follow-up for 2 - 10 years (mean 4.2 years) showed that 88.7% patients were cured and 5.6% relieved, with an effective rate of 94.3%. Recurrence rate was 3.2%, and the ineffective rate was 2.6%. The most frequent complication was hearing dysfunction (2.8%). CONCLUSIONS: MVD is the most definitive treatment method of HFS. The key procedures of this operation include adequate exposure of the REZ, identification of the offending vessels, and proper positioning of Teflon grafts. Complications can be reduced effectively by utilizing a real-time AEP monitoring during the operation.

PMID: 15989764 [PubMed - indexed for MEDLINE]

Hemifacial spasm following a blow to the mandible causing blunt injury to the peripheral facial nerve.

Neurol Med Chir (Tokyo). 2005 Apr;45(4):192-5

Authors: Shimizu S, Tanaka R, Sato S, Fujii K

A 40-year-old male presented with hemifacial spasm manifesting as paroxysmal spontaneous twitches in the left peribuccal region persisting for 3 months. The symptoms began 7 days after an accident, when a signboard hit his left mandibular angle. Physical examination showed no trauma-related change in his face, and no neurological abnormality except for the twitches. Magnetic resonance imaging also showed no abnormalities of the facial nerve and adjacent regions. Electrophysiological studies showed synkinesis, so hemifacial spasm caused by peripheral facial nerve injury was suspect- ed. The symptoms subsided 4 months after the injury. Blunt injury to the facial nerve branches might cause hemifacial spasm.

PMID: 15849456 [PubMed - indexed for MEDLINE]

[Hemifacial spasm as clinical presentation of intracranial meningiomas. Report of three cases and review of the literature]

Neurocirugia (Astur). 2005 Feb;16(1):21-5; discussion 26

Authors: G&#xF3;mez-Perals LF, Ortega-Martínez M, Fernández-Portales I, Cabezudo-Artero JM

Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is exceptional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal deficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association.

PMID: 15756407 [PubMed - indexed for MEDLINE]

Disappearance of hemifacial spasm after ventriculoperitoneal shunting in a patient with achondroplasia--case report.

Neurol Med Chir (Tokyo). 2005 Feb;45(2):104-7

Authors: Yamashita S, Matsumoto Y, Tamiya T, Kawanishi M, Ogawa D, Nagao S

A 15-year-old boy with achondroplasia developed right hemifacial spasm associated with headache, vomiting, and hearing disturbance. Computed tomography showed hydrocephalus. A ventriculoperitoneal shunt was placed. His hydrocephalus subsequently resolved, the hemifacial spasm and headache disappeared, and his hearing disturbance improved. The episodes of hemifacial spasm were probably related to a small posterior cranial fossa volume, the so-called crowding of the posterior fossa. Increased intracranial pressure due to hydrocephalus apparently contributed to further reduction in the posterior cranial fossa volume and led to the hemifacial spasms. In addition, his hearing disturbance may have been the result of dysfunction of the cochlear nerve due to the increase in intracranial pressure caused by hydrocephalus.

PMID: 15722610 [PubMed - indexed for MEDLINE]

[The long-term evolution of botulinum toxin dosage in the treatment of hemifacial spasms]

Rev Neurol. 2004 Sep 16-30;39(6):599

Authors: Garc&#xED;a-Torres MA, García-Ruiz Espiga PJ

PMID: 15468005 [PubMed - indexed for MEDLINE]

[Arterial hypertension as a risk factor for hemifacial spasm due to vascular compression]

Rev Neurol. 2004 Jul 16-31;39(2):198-9

Authors: Ioli P, Vera J, Femminini R, Gonorazky SE

PMID: 15264174 [PubMed - indexed for MEDLINE]

Hemifacial spasm in Singapore: clinical characteristics and patients ' perceptions.

Ann Acad Med Singapore. 2004 May;33(3):324-8

Authors: Au WL, Tan LC, Tan AK

INTRODUCTION: The aim of this study was to determine the clinical characteristics and patients ' perception of hemifacial spasm (HFS) in Singapore. MATERIALS AND METHODS: A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken. RESULTS: Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8 % of patients, and the orbicularis oculi was the first muscle to be affected in 86.1 % of them. The majority (65 %) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2 % of the patients, rendered 65 % of them depressed, affected the vision in 60.6 % of them and compromised their work performance in 35.8 %. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3 %) tried traditional therapies (acupuncture or herbal medicine), while only 48.2 % had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90 % showed improvement at 1 month posttreatment. CONCLUSIONS: The clinical characteristics and patients ' perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.

PMID: 15175773 [PubMed - indexed for MEDLINE]

Microvascular decompression of cranial nerves using sheets of a dural substitute--technical note.

Neurol Med Chir (Tokyo). 2004 Feb;44(2):94-100; discussion 100-1

Authors: Oiwa Y, Nakai K, Takayama M, Naka D, Itakura T

Several types of prosthesis are used for microvascular decompression (MVD) surgery for neurovascular compression syndrome. However, most prostheses adhere to the surrounding neuronal structures and occasionally cause granulomas. The present study evaluated a dural substitute made of expanded polytetrafluoroethylene, the Gore-Tex EPTFE patch, as a prosthesis for MVD. Twelve patients with trigeminal neuralgia, 19 patients with hemifacial spasm (HFS), and two patients with glossopharyngeal neuralgia underwent MVD using the dural substitute. In most cases, one or two sheets of the dural substitute were inserted between the offending artery and the compression site covering the cranial nerve and the brainstem. Thirty of the 33 patients experienced complete relief of the symptoms that lasted for at least 10-75 months after the surgery. HFS recurred one month post-surgery in a patient who underwent MVD using two small sheets. Varied grades of hearing disturbance were observed in three patients with HFS. MVD using dural substitute is an easy and efficient method because it is not necessary to move the offending arteries away from the compression site. Large sheets should be positioned over the compression site for sufficient decompression. However, this technique needs to be improved so that the prosthesis does not affect cranial nerve VIII, as three of 19 patients with HFS showed hearing disturbances despite intraoperative monitoring of the auditory brainstem response.

PMID: 15018333 [PubMed - indexed for MEDLINE]

Coexistent blepharospasm and hemifacial spasm: overlapping pathophysiologic mechanism?

J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):494-6

Authors: Tan EK, Chan LL, Koh KK

BACKGROUND/AIM: Blepharospasm (BEB) and hemifacial spasm (HFS) appear to be distinct disorders. Clinical characteristics of coexistent BEB and HFS have not been examined. The aim of this study was to determine the prevalence, clinical, and imaging features of coexistent BEB among a cohort of HFS patients and controls. RESULTS: Among 665 study subjects, nine (5.5%) of the 164 consecutive HFS patients had coexistent BEB, significantly higher than age and gender matched controls (0/501, 0%) without neurological diseases (p<0.0001). The mean age of the nine patients was 61.4 (SD 9.9) (range 51-72), consisting of 88.9% women, and 66.7% had left sided HFS, similar to HFS patients without BEB. Six (66.7%) reported BEB symptoms at a mean of 0.8 years after HFS onset, one before, and onset was undetermined in two patients. Advanced magnetic resonance imaging and angiography revealed neurovascular compression of the ipsilateral side of HFS, without any basal ganglia lesions. CONCLUSIONS: BEB occurred more frequently in HFS patients, suggesting changes in the brainstem blink reflex circuitry could play a modulatory role in certain at-risk individuals resulting in the coexistence of these movement disorders.

PMID: 14966174 [PubMed - indexed for MEDLINE]

Cerebellopontine angle epidermoid tumor presenting with hemifacial spasms.

Neurol India. 2003 Jun;51(2):288-9

Authors: Desai K, Nadkarni T, Bhayani R, Goel A

PMID: 14571040 [PubMed - indexed for MEDLINE]

Angiographic manifestations and operative findings with 70 cases of hemifacial spasm: relation of common trunk anomalies.

Keio J Med. 2003 Sep;52(3):189-97

Authors: Oizumi T, Ohira T, Kawase T

The relations between angiographic manifestations and operative findings of hemifacial spasm were studied in 70 cases between 1988 and 2001. Vertebral angiography was performed, and Towne, straight AP, and lateral projections were routinely examined. The dominant anterior inferior cerebellar artery (AICA) directly compressed the facial nerve root exit zone in 26 cases, the dominant posterior inferior cerebellar artery (PICA) in 20, the AICA in 13, the PICA in 2, and the vertebral artery (VA) in 9. Compression by multiple vessels was observed in 11 cases. Anatomical variations of the affected AICA and PICA were classified into 3 groups according to their origins and distributions of blood supply: normal distribution of AICA and PICA in 18%, common trunk anomaly with dominant AICA (basilar artery origin) in 48% and common trunk anomaly with dominant PICA (vertebral artery origin) in 34%. Analyses of the angiograms revealed significantly increased numbers of common trunk anomalies compared with cases with normal angiograms. In 18 of the 20 cases of unilateral common trunk anomalies, facial nerves were compressed by the dominant artery. Preoperative vertebral angiograms may clarify the offending vessels and their sites in most hemifacial spasm cases, thus increasing the safety of surgical interventions.

PMID: 14529152 [PubMed - indexed for MEDLINE]

Influence of age on the association between primary hemifacial spasm and arterial hypertension.

J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):979-81

Authors: Defazio G, Martino D, Aniello MS, Masi G, Logroscino G, Manobianca G, La Stilla M, Livrea P

OBJECTIVE: To investigate the association between primary hemifacial spasm and arterial hypertension. SUBJECTS: 114 patients with primary hemifacial spasm and 228 neurological controls, matched for age, sex, and referral centre, were recruited during an 18 month period from consecutive outpatients attending two neurological institutions. DESIGN: The association between exposure variables and case/control status was examined in conditional logistic regression models, adjusting simultaneously for disease duration and education level. RESULTS: Hypertension was more common among the patients with primary hemifacial spasm than among the controls. The association was independent of age, disease duration, years of schooling, and other diseases (adjusted odds ratio (OR) 2.76 (95% confidence interval (CI), 1.43 to 5.33); p = 0.002). Hypertension was associated with hemifacial spasm in both the left sided group (adjusted OR, 2.76 (1.18 to 6.44); p = 0.02) and the right sided group (adjusted OR, 3.02 (1.13 to 8.1); p = 0.03). The association of hypertension with hemifacial spasm was apparently greater in the age group < 60 years (adjusted OR, 4.2 (1.4 to 12); p = 0.008) than in the age group >/= 60 years (adjusted OR, 2.5 (CI 1.3 to 4.6); p = 0.005), but the difference in the OR estimates between the two age groups was not significant. Among hypertensive patients, mean age at the diagnosis of hypertension was significantly lower than mean age at the onset of hemifacial spasm in the age group >/= 60 years, but not significantly different in the age group < 60 years. CONCLUSIONS: The findings support the hypothesised association of primary hemifacial spasm with hypertension and raise the possibility that a different mechanism underlies the association in different age groups.

PMID: 12810800 [PubMed - indexed for MEDLINE]

[Bilateral hemifacial spasm: case report]

Arq Neuropsiquiatr. 2003 Mar;61(1):115-8

Authors: Machado FC, Fregni F, Campos CR, Limongi JC

Bilateral hemifacial spasm (BHS) is a rare focal movement disorder often associated with vascular compression of both facial nerves. The contractions are usually asymmetric and asynchronous. Typically, one side is affected first and there is a long but variable interval for the symptoms on the other side to occur. BHS must be differentiated from other conditions including blefarospasm, facial myokymia, facial tics, oromandibular dystonia, and hemimasticatory spasm. The most successful and non-invasive symtomatic treatment is botulinum toxin injections but microvascular decompression surgery is another therapeutic option. We report the case of a 70 years old man with bilateral hemifacial spasms and present a brief review of the literature.

PMID: 12715033 [PubMed - indexed for MEDLINE]

Tortuous basilar artery as cause of hemifacial spasm.

Arch Neurol. 2003 Apr;60(4):626-7

Authors: Garibaldi DC, Miller NR

PMID: 12707080 [PubMed - indexed for MEDLINE]

Botulinum toxin type B in blepharospasm and hemifacial spasm.

J Neurol Neurosurg Psychiatry. 2003 May;74(5):687

Authors: Colosimo C, Chianese M, Giovannelli M, Contarino MF, Bentivoglio AR

PMID: 12700325 [PubMed - indexed for MEDLINE]

[Bilateral hemifacial spasm: eight personal case reports]

Rev Neurol. 2002 Sep 1-15;35(5):401-3

Authors: Llaves-Est&#xE9;vez L, Chacon-Peña JR, Martínez-Fernández E, Burguera-Hernández JA, Valero C

INTRODUCTION: Hemifacial spasms consist in tonic clonic, involuntary, asymmetrical and asynchronous contractions in the territory innerved by the facial nerve. Several different causes may give rise to this disorder, the most frequent of which are vascular abnormalities in the cerebellopontine angle. Its clinical features and electrophysiological studies are commonly used in diagnosis and its etiological diagnosis is most frequently performed by means of magnetic resonance imaging. Symptoms are treated using local injections of Botulinum toxin Type A in the affected muscles. AIMS. To review our experience in the handling of this pathological condition and to determine the results of employing Botulinum toxin. PATIENTS AND METHODS: We describe the cases of bilateral hemifacial spasms that have been diagnosed in the Virgen Macarena Hospital in Seville and La Fe in Valencia since 1980, as well as the follow up after treatment with Botulinum toxin. RESULTS: We describe eight cases of this pathological condition in which patients were treated with Botulinum toxin, and in all cases there was an improvement in the symptoms. CONCLUSIONS. Treatment with Botulinum toxin is considered to be satisfactory and provides a marked improvement in the patients quality of life.

PMID: 12373668 [PubMed - indexed for MEDLINE]

Hemifacial spasm and involuntary facial movements.

QJM. 2002 Aug;95(8):493-500

Authors: Tan NC, Chan LL, Tan EK

Hemifacial spasm (HFS) is characterized by tonic and clonic contractions of the muscles innervated by the ipsilateral facial nerve. It is important to distinguish this from other causes of facial spasms, such as psychogenic facial spasm, facial tic, facial myokymia, blepharospasm, and tardive dyskinesia. Magnetic resonance imaging and angiography studies frequently demonstrate vascular compression of the root exit zone of the facial nerve. Importantly, an underlying space-occupying lesion needs to be excluded in patients with associated atypical features such as facial numbness and weakness. Botulinum toxin injection to the facial muscles is an effective treatment for HFS, with few disabling side-effects.

PMID: 12145388 [PubMed - indexed for MEDLINE]

Local injection of botulinum toxin type A for hemifacial spasm.

Neurol Med Chir (Tokyo). 2002 Jun;42(6):245-8; discussion 248-9

Authors: Oyama H, Ikeda A, Inoue S, Nakashima Y, Shibuya M

The preliminary experience of botulinum toxin treatment for hemifacial spasm is reported in this study. Five patients were treated with 10 injections of botulinum toxin in total. Botulinum toxin had a good to excellent effect in all cases. Improvement was observed 2 weeks to 1 month after the injection. The duration of improvement was 0-9 months (mean 4.2 months). The peak rank tended to decrease and the duration of improvement increased after several treatments. Hemifacial spasm caused by the anterior inferior cerebellar artery tended to subside easily. In contrast, compression by the vertebral artery was more refractory. Continuous facial spasm caused by operative trauma subsided after the injection, but paroxysmal spasm still occurred when eating or laughing. Spasm caused by trauma disappeared 4.5 months after the injection. The complications, which were facial nerve paresis in two cases (3 injections, 30%) and diplopia in one case (1 injection, 10%), were transient and subsided in 2 weeks.

PMID: 12116529 [PubMed - indexed for MEDLINE]

Hemimasticatory spasm treated with botulinum toxin: case report.

Arq Neuropsiquiatr. 2002 Jun;60(2-A):288-9

Authors: Teive HA, Piovesan EJ, Germiniani FM, Camargo CH, Sa D, Scola RH, Werneck LC

We describe a female patient with hemimasticatory spasm, a rare movement disorder due to dysfunction of the motor trigeminal nerve of unknown origin. This patient had an excellent response to botulinum toxin therapy.

PMID: 12068362 [PubMed - indexed for MEDLINE]

Snare technique of vascular transposition for microvascular decompression--technical note.

Neurol Med Chir (Tokyo). 2002 Apr;42(4):184-9; discussion 190

Authors: Shigeno T, Kumai J, Endo M, Oya S, Hotta S

Recurrence of trigeminal neuralgia (TN) or hemifacial spasm (HFS) after microvascular decompression (MVD) is not rare. The prosthesis material eventually adheres to the neurovascular structures and again transmits arterial pulsation to the nerve. A snare ligature technique using a Gore-Tex tape can be used for the transposition of the offending artery. No prosthesis is necessary once the transposition is complete. This technique requires introduction of either Gore-Tex tape or thread around the artery and suture over the petrous dura, so an adequate working space as if operating in a shallow basin is essential. Therefore, the osteoplastic craniotomy is a little larger than usual with the scalp flap entirely reflected using a semicircular skin incision. The Gore-Tex tape can be directly snared around the artery and sutured over the petrous dura. If this procedure is difficult, a thread can be attached to both ends of the Gore-Tex tape to pass the tape around the vessel. Seven patients with TN and 13 patients with HFS have undergone this surgery. Although the follow-up period is not yet long enough, there has been no case of recurrence. The present technique for MVD can provide complete and permanent transposition of the offending artery.

PMID: 12013673 [PubMed - indexed for MEDLINE]

Cerebellopontine angle epidermoid tumor presenting with 'tic convulsif' and tinnitus--case report.

Neurol Med Chir (Tokyo). 2002 Apr;42(4):162-5

Authors: Desai K, Nadkarni T, Bhayani R, Goel A

A 22-year-old female presented with a cerebellopontine angle epidermoid tumor manifesting as a rare combination of hemifacial spasm, trigeminal neuralgia, and tinnitus. Magnetic resonance imaging demonstrated the tumor distorting the brainstem and the fourth ventricle. The tumor was almost completely resected and the seventh-eighth cranial nerve complex was decompressed by mobilizing the anterior inferior cerebellar artery loop. No arterial loop was related to the trigeminal nerve. The patient was completely relieved of the "tic convulsif" and tinnitus after the surgery. The inflammatory nature of epidermoid tumor may be involved in the etiology of the syndrome. Microvascular decompression may be needed in addition to tumor removal in such cases.

PMID: 12013668 [PubMed - indexed for MEDLINE]

[Botulinum toxin in ophthalmology]

J Fr Ophtalmol. 2001 Nov;24(9):1010-2

Authors: Gu&#xE9;pratte N, Lebuisson DA

PMID: 11912832 [PubMed - indexed for MEDLINE]

Botulinum toxin A treatment for primary hemifacial spasm: a 10-year multicenter study.

Arch Neurol. 2002 Mar;59(3):418-20

Authors: Defazio G, Abbruzzese G, Girlanda P, Vacca L, Curr&#xE0; A, De Salvia R, Marchese R, Raineri R, Roselli F, Livrea P, Berardelli A

BACKGROUND: Botulinum toxin A (BTX) is the currently preferred symptomatic treatment for primary hemifacial spasm (HFS), but its long-term efficacy and safety are not known. OBJECTIVE: To assess the long-term effectiveness and safety of BTX in the treatment of primary HFS. DESIGN: Retrospective review of medical records of the 1st and 10th years of treatment. SETTING: Outpatient clinics of 4 Italian university centers in the Italian Movement Disorders Study Group. PARTICIPANTS: A series of 65 patients with primary HFS who had received BTX injections regularly for at least 10 years. MAIN OUTCOME MEASURES: Mean duration of improvement and quality of the effect induced by the preceding treatment (measured using a patient self-evaluation scale) and occurrence and duration of adverse effects in the 1st and 10th years of treatment. RESULTS: Using a mean BTX dose per treatment session similar to that used by others, we obtained a 95% response rate and an overall mean duration of improvement of 12.6 weeks during year 1. The effectiveness of BTX in relieving the symptoms of primary HFS, as measured by the response rate and average duration of improvement, remained unchanged in the 1st and 10th years. Patients needed statistically similar BTX doses in the 1st and 10th years. The rate of local adverse effects (including upper lid ptosis, facial weakness, and diplopia) diminished significantly in the 10th year of treatment. CONCLUSION: Treatment with BTX effectively induces sustained relief from symptoms of HFS in the long term, with only minimal and transient adverse reactions.

PMID: 11890846 [PubMed - indexed for MEDLINE]

Treatment of dystonia with botulinum A toxin: a retrospective study of 170 patients.

Hong Kong Med J. 1998 Sep;4(3):279-282

Authors: Kwan MC, Ko KF, Chan TP, Chan YW

OBJECTIVE: Botulinum A toxin has been reported to provide excellent symptomatic relief for patients with dystonia. To analyse the treatment, complications, and outcome of patients receiving botulinum A toxin injection, the case records of 170 patients attending the Botox Clinic at the Kwong Wah Hospital from 1 December 1992 to 31 December 1996 were reviewed. Of these 170 patients, 130 (76.5%) had idiopathic hemifacial spasm, 18 (10.6%) had blepharospasm, 18 (10.6%) had spasmodic torticollis, and 4 (2.4%) had generalised or focal limb dystonia. One hundred and sixty-six (97.6%) patients were Chinese. The average dose of botulinum A toxin required for an optimal response was 14.54 U for those with hemifacial spasm, 49.64 U for those blepharospasm, and 137 U for those with spasmodic torticollis. Among patients with hemifacial spasm, 103 (81.7%) gave a good response, 21 (16.7%) gave a partial response, and there was no response in two (1.6%) patients. The corresponding figures for patients with blepharospasm were 7 (38.9%), 10 (55.6%), and 1 (5.6%), respectively, and for those with spasmodic torticollis, the figure were 6 (37.5%), 6 (37.5%), and 4 (2.5%), respectively. Complications from botulinum A toxin injection were rare (less than 10%), minor, transient, and usually dose-related. In conclusion, idiopathic hemifacial spasm was the most common type of movement disorder encountered in our Botox Clinic and botulinum A toxin injection was safe and effective in the majority of patients.

PMID: 11830682 [PubMed - as supplied by publisher]

[Efficacy and tolerance of gabapentin in dystonia and hemifacial spasm: a pilot study]

Rev Neurol. 2001 Sep 1-15;33(5):408-10

Authors: Linazasoro Crist&#xF3;bal G

INTRODUCTION: The pharmacological management of dystonia is suboptimal. Focal dystonia and hemifacial spasm can be successfully managed with botulinum toxin injections. The physiopathology of dystonia remains a mystery. The gabaergic transmission may be involved in the origin of dystonia. Gabapentin is a gabaergic agent and therefore it can be useful in dystonia. PATIENTS AND METHODS: 28 patients with different forms of dystonia and hemifacial spasm were included in this open study. They received gabapentin (mean dose 1885 mg/d). RESULTS: Gabapentin was not efficacious but a subgroup of 6 patients (3 with hemifacial spasm, 2 with posttraumatic dystonia and 1 with spasmodic torticollis) significantly improved. Gabapentin was well tolerated. Somnolence was the most commonly reported side effect. CONCLUSION: Gabapentin may be useful in some patients with dystonia and hemifacial spasm. Double blind studies are clearly needed.

PMID: 11727203 [PubMed - indexed for MEDLINE]