Hemifacial Spasm

Rosenstengel, Christian; Matthes, Marc; Baldauf, Jörg; Fleck, Steffen; Schroeder, Henry W. S.

doi:10.3238/arztebl.2012.0667

Cited by 66 publications

(79 citation statements)

References 20 publications

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“…6 The mean annual incidence is 0.81 per 100,000 women and 0.74 per 100,000 men. Because of this low incidence, there are few studies comparing the efficacy of different therapies 7 . Anticonvulsants such as carbamazepine and clonazepam should only be used for mild presentations, as results are typically unsatisfactory 8 .…”

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confidence: 99%

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

Batisti

Kleinfelder

Galli

et al. 2017

Arq. Neuro-Psiquiatr.

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Hemifacial spasm (HFS) is a craniofacial movement disorder characterized by involuntary contractions of the muscles on one side of the face 1 . The most common site for the contractures is the orbicularis oculi muscle, but the corrugator supercilii, frontalis muscle, orbicularis oris, zygomaticus major and platysma can also be affected 2 . The condition is believed to be mainly due to a peripheral dysfunction of the facial nerve, occasionally associated with nerve compression by a blood vessel or tumor 3,4 . The pathophysiology, however, has yet to be fully elucidated as the condition can occur in the absence of structural alterations 3 . In a recent study, Wilkinson and Kaufmann 5 showed that HFS may be associated with central nervous system changes. Accordingly, one previous study from our group found similar profiles of obsessive and psychiatric symptoms in cases of HFS and blepharospasm, which is recognized as a movement disorders of A total of 550 BTX-A injections were administered to 100 HFS patients. Results: Mean duration of improvement following each injection session was 3.1 months, mean latency to detection of improvement was 7.1 days and mean success rate was 94.7%. Patients were evaluated at an interval of 5.8 months after each application. Adverse effects, which were mostly minor, were observed in 37% of the patients at least once during follow-up. The most frequent was ptosis (35.1%). Conclusion: Treatment of HFS with BTX-A was effective, sustainable and safe and had minimal, well-tolerated side effects.

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confidence: 99%

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

Batisti

Kleinfelder

Galli

et al. 2017

Arq. Neuro-Psiquiatr.

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“…Secondary causes of HFS are described as 0.0–0.6% of cases in published series,[ 31 34 ] and include the lesions of the cerebellopontine angle, schwannoma, meningioma, epidermoid tumor, lipoma, and arachnoid cyst; and processes in the brain stem, demyelinating diseases, gliomas, cavernomas, arteriovenous malformations, and strokes. [ 6 16 24 31 48 80 100 109 ] Cases of HFS secondary to Paget's disease have also been described. [ 21 24 ]…”

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confidence: 99%

Tenth case of bilateral hemifacial spasm treated by microvascular decompression: Review of the pathophysiology

Martins¹,

Albuquerque²,

Carvalho³

et al. 2017

Surg Neurol Int

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Background:Bilateral hemifacial spasm (BHFS) is a rare neurological syndrome whose diagnosis depends on excluding other facial dyskinesias. We present a case of BHFS along with a literature review.Methods:A 64-year-old white, hypertense male reported involuntary left hemiface contractions in 2001 (aged 50). In 2007, right hemifacial symptoms appeared, without spasm remission during sleep. Botulinum toxin type A application produced partial temporary improvement. Left microvascular decompression (MVD) was performed in August 2013, followed by right MVD in May 2014, with excellent results. Follow-up in March 2016 showed complete cessation of spasms without medication.Results:The literature confirms nine BHFS cases bilaterally treated by MVD, a definitive surgical option with minimal complications. Regarding HFS pathophysiology, ectopic firing and ephaptic transmissions originate in the root exit zone (REZ) of the facial nerve, due to neurovascular compression (NVC), orthodromically stimulate facial muscles and antidromically stimulate the facial nerve nucleus; this hyperexcitation continuously stimulates the facial muscles. These activated muscles can trigger somatosensory afferent skin nerve impulses and neuromuscular spindles from the trigeminal nerve, which, after transiting the Gasser ganglion and trigeminal nucleus, reach the somatosensory medial posterior ventral nucleus of the contralateral thalamus as well as the somatosensory cortical area of the face. Once activated, this area can stimulate the motor and supplementary motor areas (extrapyramidal and basal ganglia system), activating the motoneurons of the facial nerve nucleus and peripherally stimulating the facial muscles.Conclusions:We believe that bilateral MVD is the best approach in cases of BHFS.

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“…Inclusion criteria were (a), diagnosis of primary HFS based on the clinical presentation and identification of the responsible vessel by brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), or surgical operation (Rosenstengel, Matthes, Baldauf, Fleck, & Schroeder, 2012);and (b), no significant clinical improvements after conservative treatments, such as botulinum toxin injection, acupuncture, and traditional Chinese medicine. Exclusion criteria were (a), diagnosis of secondary HFS or atypical facial spasm and (b), contraindicated for MVD surgery.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Microvascular decompression in patients with hemifacial spasm

et al. 2019

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PurposeTo study blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS).MethodsA retrospective study was performed to review HFS patients who received MVD surgery between January 2014 and December 2016. Vessels that were considered to be responsible for HFS were determined by reviewing the brain magnetic resonance imaging, magnetic resonance angiography, and surgical video. Blood pressure measurements were performed 1 day before (preoperative) and 7 days after (postoperative) the MVD surgery. Pre‐ and postoperative blood pressure measurements were compared.ResultsA total of 374 patients were included in the study, with 118 (31.6%) male patients, age 53.8 ± 9.9 years old, and 141 (37.7%) patients with hypertension. Systolic blood pressure had statistically significant decrease in patients with (134.5 ± 8.2–132.6 ± 9.1 mmHg, p = .01) or without (125.6 ± 9.1–123.8 ± 10.0 mmHg, p = .01) hypertension. Diastolic blood pressure only had statistically significant decrease in patients with hypertension (83.0 ± 5.8–82.0 ± 6.5 mmHg, p = .04). Analyses in all the study patients and in the subgroup of patients with hypertension showed that more statistically significant blood pressure reductions were observed when left‐side vessel or vertebrobasilar artery was involved.ConclusionIn patients with HFS, MVD not only decreased blood pressure in patients with hypertension but also affected blood pressure in patients without hypertension. Blood pressure reductions were more prominent when left‐side vessel or vertebrobasilar artery was involved.

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Hemifacial Spasm

Abstract: Local botulinum-toxin injection is a safe and well-tolerated symptomatic treatment for hemifacial spasm. In the long term, however, lasting relief can only be achieved by microvascular decompression, a microsurgical intervention with a relatively low risk and a high success rate.

Cited by 66 publications

References 20 publications

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

Tenth case of bilateral hemifacial spasm treated by microvascular decompression: Review of the pathophysiology

Microvascular decompression in patients with hemifacial spasm

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