1
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Aktan D, Depierreux F. How to face the hemifacial spasm: challenges and misconceptions. Acta Neurol Belg 2024; 124:17-23. [PMID: 37498482 DOI: 10.1007/s13760-023-02342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
Hemifacial spasm (HFS) is characterised by intermittent, brief or sustained, repetitive contractions of the muscles innervated by one facial nerve. It is one of the most frequent movement disorders affecting the face. However common and allegedly straightforward to diagnose, it might reveal as a challenge for clinicians in various situations. Indeed, it often needs prior exclusion of many other movement disorders affecting the face, with frequent phenomenological overlaps with blepharospasm, post-facial palsy, facial motor tics, etc. The clinical diagnosis shall be supported by modern brain imaging techniques, and sometimes electromyography, as some particular aetiologies may require specific treatment. Primary forms are associated with vascular compression of the ipsilateral seventh cranial nerve, whereas secondary forms can be caused by any injury occurring on the facial nerve course. This article proposes a global and organised approach to the diagnosis, and the ensuing therapeutic options, as many practitioners still use some inefficient medications when they encounter a case of facial spasm.
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Affiliation(s)
- David Aktan
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium.
| | - Frédérique Depierreux
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium
- Movement Disorder Unit, Neurology Department, CHU Liège, Liège, Belgium
- GIGA-CRC in vivo imaging, University of Liège, Liège, Belgium
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2
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Herrero-Infante Y, Rodríguez-Sanz A, Máñez-Miró J, Vivancos-Matellano F. Hemifacial spasm through the last three decades: From etiology to efficacy and safety of long-term botulinum toxin treatment. Clin Neurol Neurosurg 2021; 203:106555. [PMID: 33662742 DOI: 10.1016/j.clineuro.2021.106555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/02/2021] [Accepted: 02/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is an uncommon movement disorder characterized by involuntary contractions of muscles innervated by the facial nerve. The aim of this study is to analyze the etiology of HFS as well as the efficacy and safety of long-term botulinum toxin type A (BTX-A) treatment. METHODS Retrospective study including 125 patients with HFS treated with BTX-A from 1993 to 2019. Demographic and etiological variables as well as doses, number of sessions of BTX-A, infiltrated muscles, therapeutic response according to Patient Global Impression of Change Scale (PGIC-S), side effects and adjuvant treatments were analyzed. In addition, these variables were compared according to the etiology (idiopathic versus secondary). RESULTS 92 patients (73.6%) were women and the mean age at diagnosis was 58.63 years (SD 15.4). The etiology was idiopathic in 79 patients (63.2%), 17.6% were secondary to Bell's palsy, 14.4% to vascular compression and 2.4% to tumors. A higher total dose per session was observed in the secondary group. PGIC-S showed a good response in 96% of cases. 16 patients (12.8%) required pharmacological concomitant treatment. 59 patients (47.2%) developed side effects. Transient eyelid ptosis and facial weakness were the most common. CONCLUSIONS The structural origin of a significant number of cases of HFS makes essential to complete an etiological diagnosis in all patients. In addition, the existence of a secondary cause could be associated with greater doses of BTX-A to achieve a good response. Regardless the etiology, long-term treatment with BTX-A in HFS is safe and effective.
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Affiliation(s)
- Yolanda Herrero-Infante
- Movement Disorders Unit, Neurology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Ana Rodríguez-Sanz
- Movement Disorders Unit, Neurology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Jorge Máñez-Miró
- Movement Disorders Unit, Neurology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Francisco Vivancos-Matellano
- Movement Disorders Unit, Neurology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
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3
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Dong W, Jin SC, Allocco A, Zeng X, Sheth AH, Panchagnula S, Castonguay A, Lorenzo LÉ, Islam B, Brindle G, Bachand K, Hu J, Sularz A, Gaillard J, Choi J, Dunbar A, Nelson-Williams C, Kiziltug E, Furey CG, Conine S, Duy PQ, Kundishora AJ, Loring E, Li B, Lu Q, Zhou G, Liu W, Li X, Sierant MC, Mane S, Castaldi C, López-Giráldez F, Knight JR, Sekula RF, Simard JM, Eskandar EN, Gottschalk C, Moliterno J, Günel M, Gerrard JL, Dib-Hajj S, Waxman SG, Barker FG, Alper SL, Chahine M, Haider S, De Koninck Y, Lifton RP, Kahle KT. Exome Sequencing Implicates Impaired GABA Signaling and Neuronal Ion Transport in Trigeminal Neuralgia. iScience 2020; 23:101552. [PMID: 33083721 PMCID: PMC7554653 DOI: 10.1016/j.isci.2020.101552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
Trigeminal neuralgia (TN) is a common, debilitating neuropathic face pain syndrome often resistant to therapy. The familial clustering of TN cases suggests that genetic factors play a role in disease pathogenesis. However, no unbiased, large-scale genomic study of TN has been performed to date. Analysis of 290 whole exome-sequenced TN probands, including 20 multiplex kindreds and 70 parent-offspring trios, revealed enrichment of rare, damaging variants in GABA receptor-binding genes in cases. Mice engineered with a TN-associated de novo mutation (p.Cys188Trp) in the GABAA receptor Cl− channel γ-1 subunit (GABRG1) exhibited trigeminal mechanical allodynia and face pain behavior. Other TN probands harbored rare damaging variants in Na+ and Ca+ channels, including a significant variant burden in the α-1H subunit of the voltage-gated Ca2+ channel Cav3.2 (CACNA1H). These results provide exome-level insight into TN and implicate genetically encoded impairment of GABA signaling and neuronal ion transport in TN pathogenesis. Genomic analysis of trigeminal neuralgia (TN) using exome sequencing Rare mutations in GABA signaling and ion transport genes are enriched in TN cases Generation of a genetic TN mouse model engineered with a patient-specific mutation
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Affiliation(s)
- Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - August Allocco
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Xue Zeng
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Amar H Sheth
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Annie Castonguay
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada
| | | | - Barira Islam
- University College London, School of Pharmacy, London, England
| | | | - Karine Bachand
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada
| | - Jamie Hu
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Agata Sularz
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Gaillard
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jungmin Choi
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA.,Department of Biomedical Sciences, Korea University College of Medicine, 02841 Seoul, Korea
| | - Ashley Dunbar
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Emre Kiziltug
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Sierra Conine
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Phan Q Duy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Erin Loring
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Boyang Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Qiongshi Lu
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Geyu Zhou
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Wei Liu
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Michael C Sierant
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Shrikant Mane
- Yale Center for Genome Analysis, West Haven, CT, USA
| | | | | | | | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York
| | | | | | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jason L Gerrard
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sulayman Dib-Hajj
- Center for Neuroscience & Regeneration Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology; Yale University, New Haven, CT, USA
| | - Stephen G Waxman
- Center for Neuroscience & Regeneration Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology; Yale University, New Haven, CT, USA
| | - Fred G Barker
- Harvard Medical School, Boston, MA, USA.,Cancer Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Seth L Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mohamed Chahine
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada.,Department of Medicine, Université Laval, Québec, QC, Canada
| | - Shozeb Haider
- University College London, School of Pharmacy, London, England
| | - Yves De Koninck
- CERVO Brain Research Centre, Université Laval, Québec, QC, Canada.,Department of Psychiatry and Neuroscience, Université Laval, Québec, QC, Canada
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.,Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
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Abstract
OPINION STATEMENT The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.
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Affiliation(s)
- Kemar E Green
- Departments of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - David Rastall
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eric Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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5
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Familial hemifacial spasm of young-onset: Report of two cases. J Neurol Sci 2017; 373:83-85. [PMID: 28131234 DOI: 10.1016/j.jns.2016.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
Abstract
Hemifacial spasm (HFS) is defined as an involuntary twitching of the hemifacial muscles supplied by the facial nerve. It is mostly attributed to a vascular compression with the facial nerve. Familial HFS has been described in less than 10% of cases of sporadic HFS and usually develops after the age of 40. Young-onset HFS is a rare condition, generally presenting prior to the age of 30 with an estimated prevalence of 6.5% of sporadic HFS. No familial component has been described in small series of young-onset HFS. Here we report the cases of a patient and his mother who both developed right HFS in their early twenties. Both patients had a neurovascular contact between their right facial nerve and a branch of their right posterior inferior cerebellar artery. Our report explores how young-onset familial HFS may be the consequence of hereditary vascular variations.
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6
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Distinguishing features of psychogenic (functional) versus organic hemifacial spasm. J Neurol 2016; 264:359-363. [DOI: 10.1007/s00415-016-8356-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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7
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Edmond EC, Sim SXL, Li HH, Tan EK, Chan LL. Vascular tortuosity in relationship with hypertension and posterior fossa volume in hemifacial spasm. BMC Neurol 2016; 16:120. [PMID: 27473840 PMCID: PMC4966585 DOI: 10.1186/s12883-016-0634-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Hemifacial spasm (HFS) is a disabling neurological condition. Vascular tortuosity in HFS patients has not been quantified objectively and its relationship with hypertension and posterior fossa volume (PF) is unknown. In a case control magnetic resonance imaging and angiographic (MRI/A) study, we quantified and compared the vascular tortuosity in HFS and controls, and evaluated its relationship with hypertension and PF. Methods Using a commercially available vessel probe tool, an index of tortuosity based on vessel over chord length was employed to quantify vascular tortuosity of the vertebral (VA) and basilar arteries (BA) in 79 subjects (40 HFS, 39 controls). Results The tortuosity index of the BA (1.09 vs 1.16, p = 0.26, 95 % CI 1.07, 1.23), RVA (1.15 vs 1.15, p = 0.83, 95 % CI 1.06, 1.38) and LVA (1.14 vs 1.288, p = 0.16, 95 % CI 1.14, 1.44) was not different between HFS and controls, with adjustments for PF volume and hypertension. Conclusions Contrary to popular belief, our study showed that taking into account hypertension and PF volume, vascular tortuosity of the vertebrobasilar arteries is unlikely to be a major etiologic factor in HFS, though its role in select individuals cannot be excluded. The complex interplay of facial nerve hyperexcitability, genetic predisposition, vascular tortuosity, posterior fossa volume and hypertension needs to be further evaluated.
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Affiliation(s)
- Evan Cyril Edmond
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore.,Oxford Medical School, Oxford, UK
| | - Samantha Xue-Li Sim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore.,Duke NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Hui-Hua Li
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, Singapore, 169608, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Duke NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Ling-Ling Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore. .,Duke NUS Graduate Medical School, Singapore, 169857, Singapore.
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8
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Kim YG, Jung NY, Kim M, Chang WS, Jung HH, Chang JW. Benefits of microvascular decompression on social anxiety disorder and health-related quality of life in patients with hemifacial spasm. Acta Neurochir (Wien) 2016; 158:1397-404. [PMID: 27155866 DOI: 10.1007/s00701-016-2822-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS), an involuntary movement disorder characterized by unilateral spasms of the muscles innervated by the facial nerve, is likely to cause social anxiety disorder due to its significant facial disfigurement and may have a significant influence on a patient's health-related quality of life (HRQoL). The goal of this study was to investigate the influence of microvascular decompression (MVD) on the severity of social anxiety symptoms and HRQoL in patients with HFS. METHODS Patients who underwent MVD from January to May 2015 were included in this study. Demographic data were collected before surgery. Clinical data, including the standardized measures of anxiety and depression (Hospital Anxiety Depression Scale, HADS), social anxiety (Liebowitz Social Anxiety Scale, LSAS), and the severity of HFS were assessed before surgery and 6 months after surgery. HRQoL data were also collected before surgery and 6 months after surgery using the Korean version of the short form 36 (SF-36). RESULTS Six patients (21.4 %) scored 60 or greater on the preoperative LSAS and were considered to have generalized social anxiety disorder (high-LSAS group). The duration of symptom was significantly higher in the high-LSAS group than in the low-LSAS group (7.8 ± 2.2 vs. 4.1 ± 2.6; p = 0.011). The high-LSAS group was more likely to have psychological comorbidities and had a more impaired quality of life than the low-LSAS group at preoperative evaluation. Six months after MVD, a significant improvement, compared to preoperative scores, was observed for the total LSAS score (p = 0.007) and anxiety subscale score of HADS (p = 0.012) in the high-LSAS group. Other significant improvements were also observed in role-emotional (p = 0.039) and mental component summary (p = 0.024) of the SF-36 in the high-LSAS group compared to the low-LSAS group. CONCLUSIONS This study shows that HFS patients seem to gain benefits from MVD not only for their facial disfigurement but also for social anxiety symptoms that may be associated with mental health improvements in their quality of life.
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Affiliation(s)
- Young Goo Kim
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - MinSoo Kim
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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9
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Chung M, Han I, Chung SS, Huh R. Side predilections of offending arteries in hemifacial spasm. J Clin Neurosci 2016; 29:106-10. [DOI: 10.1016/j.jocn.2015.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/11/2015] [Indexed: 11/16/2022]
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10
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Park JH, Jo KI, Lee HS, Lee JA, Park K. Microvascular decompression for familial hemifacial spasm : single institute experience. J Korean Neurosurg Soc 2013; 53:1-5. [PMID: 23440303 PMCID: PMC3579075 DOI: 10.3340/jkns.2013.53.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/05/2012] [Accepted: 01/07/2013] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to evaluate the characteristics and surgical outcomes of familial hemifacial spasm (HFS) and to discuss the role of genetic susceptibility. Methods Between 2001 and 2011, 20 familial HFS patients with ten different pedigrees visited our hospital. The data from comprehensive evaluation of these patients, including clinical, radiological and electrophysiological data and surgical outcomes were reviewed to characterize familial HFS and to compare the characteristics between familial HFS and sporadic HFS. Results According to the family tree, the inheritance pattern was difficult to define clearly using these data. Radiologic findings suggested that the vertebral artery (VA) was a more frequent offender in familial HFS than in sporadic cases (35.0% vs. 10.0%, p<0.001). Chi-square test showed that there were no correlation between VA tortuosity and underlying morbidity such as diabetes or hypertension (p=0.391). Eighteen out of 19 patients who underwent microvascular decompression showed no residual spasm. Other features of familial HFS overlap with sporadic cases. These findings suggest that certain genetic susceptibilities rather than hypertension or diabetes may influence vascular tortuosity and HFS development. Conclusion In this study, familial HFS seems not so different from sporadic cases. Authors thought familial HFS could have heterogeneous etiology. Further study of familial HFS including clinical, anatomic, genetic, and molecular information may help identify a gene or trait that can provide insight into the mechanisms of sporadic and familial HFS.
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Affiliation(s)
- Jae-Han Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Specchio N, Trivisano M, Bernardi B, Marras CE, Faggioli R, Fiumana E, Cappelletti S, Delalande O, Vigevano F, Fusco L. Neonatal hemifacial spasm and fourth ventricle mass. Dev Med Child Neurol 2012; 54:697-703. [PMID: 22548445 DOI: 10.1111/j.1469-8749.2012.04247.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Congential hemifacial spasm is a rare condition that is characterized by the occurrence of paroxysmal hemifacial contractions in neonates. We review the clinical, neurophysiological, neuroimaging, and histopathological findings, as well as the differential diagnosis, therapeutic approach, and outcome of all the described cases. Moreover, we report two new cases including the ictal video-electroencephalography recordings. Hemifacial spasm starts early in life, and is characterized by unilateral, involuntary, irregular tonic or clonic contractions of muscles innervated by the seventh cranial nerve. Hemifacial spasm is associated with eyelid blinking, and sometimes with breathing irregularities, hyperventilation, and/or other neurological manifestations (dystonic movements, nystagmus). Interictal and ictal video-electroencephalography did not reveal epileptiform abnormalities. In all cases, brain magnetic resonance imaging showed a mass involving the cerebellar peduncle, the cerebellar hemisphere, or the floor of the fourth ventricle. The semiology of the paroxysmal attacks is probably due to the activation of cranial nerve nuclei through intralesional hypersynchronous discharges, as shown by the intraoperative recordings and functional brain imaging described in the literature. We point out the importance of identifying such seizures in order to make an early diagnosis of the underlying cerebral lesion.
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Affiliation(s)
- Nicola Specchio
- Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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12
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Yaltho TC, Jankovic J. The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord 2011; 26:1582-92. [PMID: 21469208 DOI: 10.1002/mds.23692] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/29/2011] [Accepted: 02/03/2011] [Indexed: 11/06/2022] Open
Abstract
Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n=23, 11%), facial nerve injury (n=13, 6%), demyelination (n=2), and brain vascular insults (n=2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features.
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Affiliation(s)
- Toby C Yaltho
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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13
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Abstract
Hemifacial spasm (HFS) is a peripherally induced movement disorder causing clonic or tonic contractions of the facial muscles. HFS is usually unilateral and sporadic. It may be primary (mainly attributed to vascular compressions of the seventh cranial nerve in the posterior fossa) or secondary to facial nerve or brainstem damage. The two forms share a number of features but may differ in clinical presentation (simultaneous involvement of the upper and lower facial muscles in secondary forms). The spasm-related electromyogram activity is probably generated by ephaptic transmission, due to local demyelination at the entry zone of the facial nerve root (possibly owing to nerve damage caused by a compressing cerebral vessel). These findings suggest the "nerve origin hypothesis" as the main pathophysiological mechanism underlying HFS. Medical treatment (anticonvulsants or GABAergic drugs) is generally ineffective. Microvascular decompression of the facial nerve can achieve marked improvements in the majority of patients, although recurrences and complications are not uncommon. Local (orbicularis oculi or lower facial muscles) injection of Botulinum toxin (BoNT) is therefore considered the preferred symptomatic treatment for primary HFS. The long-term efficacy and safety of BoNT have been documented by clinical studies.
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Familial hemifacial spasm and determinants of late onset. Neurol Sci 2009; 31:17-22. [DOI: 10.1007/s10072-009-0153-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
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Portera-Cailliau C. Facial twitching. Mov Disord 2008. [DOI: 10.3109/9780203008454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Closely Spaced Stressful Life Events Precede the Onset of Benign Essential Blepharospasm and Hemifacial Spasm. J Neuroophthalmol 2007; 27:275-80. [DOI: 10.1097/wno.0b013e31815c4233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Felicio AC, Godeiro-Junior CDO, Borges V, Silva SMDA, Ferraz HB. Clinical assessment of patients with primary and postparalytic hemifacial spasm: a retrospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:783-6. [DOI: 10.1590/s0004-282x2007000500009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/08/2007] [Indexed: 11/22/2022]
Abstract
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.
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Abstract
INTRODUCTION Hemifacial spasm (HFS) frequently affects middle aged individuals and the clinical features and etiology have been well reported. However, there is limited data on the exact pathogenesis in young-onset HFS. If age is a major determinant of the etiology or influences the presentation of HFS, there may be clinical differences between the young and elderly HFS patients. OBJECTIVES We determined the prevalence, clinical and imaging features of young-onset HFS (age of onset<or=30 years) in a tertiary referral center. These data were compared with old onset (age of onset>or=65 years) HFS patients. METHODS We examined consecutive patients clinically diagnosed with HFS in a tertiary referral center. The clinical (demographics, clinical presentation, severity of HFS, associated medical conditions and other variables) and imaging findings of young onset patients and old onset patients were tabulated and compared. RESULTS Amongst 230 consecutive HFS patients, 15 (6.5%) were young-onset HFS and 50 (21.7%) were old-onset HFS. In the young-onset HFS, the mean age of onset of symptoms was 26.5+/-6.5 (6-30) years, with 80% women and 75.0% of young onset HFS having neurovascular compression (NVC) of the root exit zone (REZ) of the facial nerve on the ipsilateral side; 86.7% had initial onset of twitching in the upper eyelids that later progressed to the lower facial muscles. While the prevalence of hypertension, diabetes mellitus and other associated vascular disorders in late onset HFS was higher than in young onset groups, the clinical features and frequency of NVC of the facial REZ between the two groups were similar. CONCLUSIONS We demonstrated a 6.5% frequency of young-onset HFS in our cohort of HFS and their clinical presentation was similar to the old onset patients. Genetic, anatomic or other unidentified factors may contribute to NVC in young-onset HFS.
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Affiliation(s)
- E K Tan
- Department of Neurology, Singapore General Hospital, Singapore.
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Abstract
Hemifacial spasm (HFS) is a peripheral movement disorder caused by direct or indirect compression or distortion of the root exit zone of the seventh cranial nerve, which is most commonly compressed by an arterial loop, but also may be compressed by a tumor, cyst, or aneurysm. All patients with HFS should undergo magnetic resonance imaging, with particular attention to the seventh cranial nerve. For patients with HFS who want treatment, there are three options. Oral medications, particularly anticonvulsants, may be useful, but the response rate is low and evidence is almost exclusively anecdotal. Local injection of botulinum toxin into the overactive muscles has a very high rate of success and virtually no serious side effects. Backed by controlled clinical trials, the authors consider it the treatment of choice. Microvascular surgical decompression has the advantage of being potentially curative, and obviates the need for chronic injections with botulinum toxin. However, surgery carries much greater risk than botulinum toxin and the spasm may recur. It is important that surgery is carried out by an experienced neurosurgeon to reduce the risk.
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Affiliation(s)
- Lawrence W. Kemp
- Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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