Unusual Causes and Presentations of Hemifacial Spasm

Han, In Ho; Chang, Jong Hee; Chang, Jin Woo; Huh, Ryoong; Chung, Sang Sup

doi:10.1227/01.neu.0000348548.62440.42

Cited by 74 publications

(49 citation statements)

References 18 publications

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“…A proportion of patients received oral treatment with a large array of medications even though they did not receive a diagnosis. BoNT injections reached good/excellent results in 76-100% of patients according to previous series 1,10,18 . Misdiagnosis leads to a direct impact in QoL, social distress and impairment in activities of daily living such as driving or reading 3,5,10,11 .…”

Section: Discussionmentioning

confidence: 74%

“…BoNT injections reached good/excellent results in 76-100% of patients according to previous series 1,10,18 . Misdiagnosis leads to a direct impact in QoL, social distress and impairment in activities of daily living such as driving or reading 3,5,10,11 . Nearly 50% of the patients evaluated in this series were unemployed by the time they reached the tertiary center and considered HFS as a contributing factor for this status.…”

Section: Discussionmentioning

confidence: 74%

“…cases (0.6%) were composed by masses or arterivenous malformation 10 . Although the vascular etiology is accepted, the evidence of a neurovascular conflict is present in 25% of asymptomatic subjects, leading to the fact that the HFS could not be explained only by the neurovascular compression 1,8 .…”

Section: Introductionmentioning

confidence: 99%

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Misdiagnosis of hemifacial spasm is a frequent event in the primary care setting

Martinez

Nunes

Immich

et al. 2014

Arq. Neuro-Psiquiatr.

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Primary hemifacial spasm (HFS) is characterized by irregular and involuntary contraction of the muscles innervated by the ipsilateral facial nerve. Treatment controls symptoms and improves quality of life (QoL). Objective : Evaluate the initial diagnosis and treatment of HFS prior to referral to a tertiary center. Method : We interviewed through a standard questionnaire 66 patients currently followed in our center. Results : Mean age: 64.19±11.6 years, mean age of symptoms onset: 51.9±12.5 years, male/female ratio of 1:3. None of the patients had a correct diagnosis in their primary care evaluation. Medication was prescribed to 56.8%. Mean time from symptom onset to botulinum toxin treatment: 4.34 ±7.1 years, with a 95% satisfaction. Thirty percent presented social embarrassment due to HFS. Conclusion : Despite its relatively straightforward diagnosis, all patients had an incorrect diagnosis and treatment on their first evaluation. HFS brings social impairment and the delay in adequate treatment negatively impacts QoL.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 74%

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Misdiagnosis of hemifacial spasm is a frequent event in the primary care setting

Martinez

Nunes

Immich

et al. 2014

Arq. Neuro-Psiquiatr.

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“…Recently, there have been reports that not only the TRZ/CNS but also the other segments of the facial nerve can cause the HFS 8,10,18,28,31,36) . The distal cisternal segment and even the extracranial portion of the facial nerve have been reported to be sites causing HFS 2,7,8,10,18,28,31) . In patients with the HFS, both partial demyelination and axonal degeneration of the seventh cranial nerve may be essential to produce the hyperactivity of the facial motor nucleus.…”

Section: Compression Sitesmentioning

confidence: 99%

Infranuchal Infrafloccular Approach to the More Vulnerable Segments of the Facial Nerve in Microvascular Decompressions for the Hemifacial Spasm

Park

Chang

Han

2009

J Korean Neurosurg Soc

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Objective : We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods : A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results : Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion : The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.

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“…Hemifacial spasm is a type of chronic focal dystonia, and the pathogenesis of this disease remains to be clarified because it is caused by a variety of reasons (Campos-Benitez and Kaufmann, 2008;Han et al, 2009;Guan et al, 2011). Although hemifacial spasm is commonly observed in clinical practice, treatment for this disease remains a challenge for neurologists.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: a randomized double-blind crossover trial

Huang

Ding

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of our study was to evaluate the efficacy and safety of two concentrations of botulinum toxin A (BTX-A) for the treatment of hemifacial spasm. We randomly divided 20 patients with hemifacial spasm into high-and low-concentration groups; they were administered 50 and 25 U/mL BTX-A injection, respectively. Further, we compared the curative effects and the occurrence of adverse reactions in the two groups. Our results showed that both the concentrations of BTX-A were effective and no significant difference was observed in the onset time and therapeutic efficacy between the two groups; however, the duration of efficacy was longer in the high-concentration group than in the low-concentration group. Patients in both groups had no allergic reactions and systemic toxic reactions, but those in the highconcentration group had more serious adverse reactions and they lasted for longer durations. The adverse reactions in the two groups were not specifically treated, and they resolved in a relatively short time. In conclusion, local injection of BTX-A was effective in treating hemifacial spasm and each concentration of BTX-A had advantages and disadvantages, which indicated that the concentration of BTX-A 1137 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (1): 1136-1144 (2015) Botulinum toxin A for the treatment of hemifacial spasm can be selected according to the clinical characteristics and willingness of the patients.

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Unusual Causes and Presentations of Hemifacial Spasm

Cited by 74 publications

References 18 publications

Misdiagnosis of hemifacial spasm is a frequent event in the primary care setting

Misdiagnosis of hemifacial spasm is a frequent event in the primary care setting

Infranuchal Infrafloccular Approach to the More Vulnerable Segments of the Facial Nerve in Microvascular Decompressions for the Hemifacial Spasm

Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: a randomized double-blind crossover trial

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