Using the New Clinical Grading Scale for Quantification of the Severity of Hemifacial Spasm: Correlations with a Quality of Life Scale

Abstract

Background: To date, no consensus has been reached regarding validated and practical tools to quantify the severity of hemifacial spasm (HFS) before and after surgery. Objective: The aim of this study has been to establish objective parameters for determining the preoperative severity of HFS and to assess the correlation with quality of life (QoL) in HFS patients. Methods: Patients who experienced HFS between April and August 2010 were reviewed. The patients were divided into four groups according to the severity of spasm (SMC grade): grade I – localized spasm around the periocular area; grade II – involuntary movement spreads to other parts of the ipsilateral face and it affects other muscle groups, i.e. the orbicularis oris, zygomaticus, frontalis or platysma muscle; grade III – interference with vision because of frequent tonic spasms, and grade IV – disfiguring asymmetry. We interviewed each patient using an HFS-7 questionnaire containing a short self-rating QoL scale. We estimated the measure of agreement across observers and examined the relationships between SMC grade and other factors, including HFS-7 responses. Results: Preoperative evaluation using the SMC grading system showed 25 patients with grade I, 48 patients with grade II, 33 patients with grade III, and 12 patients with grade IV HFS. The HFS-7 scores indicating QoL were 9 (range: 0–17) in grade I, 12 (range: 1–25) in grade II, 16 (range: 2–23) in grade III, and 17 (range: 3–24) in grade IV subjects. SMC grade was correlated with symptom duration (p < 0.0001) and HFS-7 score (p = 0.02). In addition, higher SMC grade was closely associated with longer duration of persisting symptoms (p < 0.05). Conclusions: An SMC grading system is useful as a means of quantifying spasms to allow for more precise descriptions of a patient’s condition including QoL, and to improve the accuracy of communication between medical teams.

Natural History of Untreated Hemifacial Spasm: A Study of 104 Consecutive Patients over 5 Years

“…The follow-up studies by other researchers have been after botulinum toxin therapy [4,7,9,15]; our results are consistent with theirs in supporting the debilitating nature of HFS and the need for treatment among the relatively high proportion of patients for whom HFS lasts. In contrast, our results describe a higher proportion of patients in remission.…”

“…The data analyzed included demographics and clinical data, i.e., gender, age, age at symptom onset, symptom duration, symptom severity at first visit, symptom location, compressing vessels, past history, treatment status and symptom course. Spasm severity was divided into 4 groups using the SMC grading system [15]. …”

Thin‐slice T2 MRI imaging predicts vascular pathology in hemifacial spasm: A case‐control study

“…V C 2014 International Parkinson and Movement Disorder Society Key W ords: hemifacial spasm; microvascular decompression; MRI; botulinum toxin; facial nerve Characterized by unilateral hyperactivity of the facial nerve, hemifacial spasm (HFS) can severely reduce a patient's quality of life. [1][2][3][4] Microvascular decompression (MVD), which has been shown to be the most effective therapy for HFS, treats the disease cause by eliminating neurovascular compression. 5,6 The development of higher-resolution magnetic resonance imaging (MRI) pulse sequences and cranial nerve-specific image processing techniques has led to an increased interest in preoperative MRI as a means to detect neurovascular compression.…”

Safety and Effectiveness of Microvascular Decompression for the Treatment of Hemifacial Spasm in the Elderly

“…The severity of HFS was graded using SMC grade [15] and the clinical course was classified as three types: periocular-onset type (spasm presents in the periocular area first), perioral-onset type (perioral involvement at symptom onset) and hemi-onset type (spasm in hemifacial area at the onset). Offending vessels and indentation of root exit zone by compressing vessels were revealed based on the surgical findings and indentation was categorized into three grades [16].…”