Abstract
IntroductionHemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of muscles of facial expression which is innervated by the facial nerve. The condition is unilaterally, beginning in the orbicularis occuli, and later on progress to involve the perioral, platysma, and other muscles of facial expression. Endoscopic assisted microvascular decompression is considered the state of the art in hemi-facial spasm surgery. New antiepileptic have emerged with a new hope for good control with few side effects. Botulinum toxin is still a good option for some patients.MethodsThis study is a prospective study that was conducted on 30 patients with primary hemifacial spasm. Bilateral and secondary cases where excluded. All patients were subjected to proper pre-treatment assessment including; proper history taking, clinical examination, and proper radiological investigations (MRI, FISTA) when needed. They were divided into three groups according to treatment modality: group A where patient's general condition was unfit for surgical intervention, received oral medications (gabapentin or levetiracetam); group B included those patients unfit for surgical intervention and did not respond to oral therapy, received Botox injection; and group C underwent endoscopic assisted microvascular decompression. Follow-up period ranged from 6 to 24 months. Outcome of different treatment modalities were compared among different groups.ResultsAmong group A patients, one patient showed excellent response to treatment (Gabapentin 1200 mg), three patients had good response, four patients had fair response, and three patients had poor response to treatment (one used levetiracetam, two used gabapentin). Overall success rate is 72.7%. Among group B patients, four patients enjoyed excellent response. Another four patients had good response, while three patients had fair response. Only one patient had poor response. Overall success rate was 83.3%. Among group C patients, five cases had excellent outcome and two cases had good outcome. Overall success rate is 100%.ConclusionEndoscopic assisted microvascular decompression offers the best chance to permanent cure with low complication rate. New antiepileptics (levetiracetam, gabapentin) provide a safe therapy for patients refusing surgical intervention. Botox is an attractive local therapy with reversible complications but with non-sustainable effect. From our results, we conclude that endoscopic assisted microvascular decompression is superior to either BOTOX or antiepiletics for the permanent cure of hemifacial spasm.
Highlights
Hemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of the muscles of facial expression which is innervated by the facial nerve
Two patients suffered from somnolence, while one patient suffered from confusion that necessitated reduction of the dose (Gabapentin, Fig. 1)
Hypertension and diabetes prevailed among our patients, similar observation noted by Chaudhry et al, who stated that hemifacial spasm and hypertension were coexistent in 40% of cases and hypertension can cause vessel ectasia which is the underlying etiology in most of the patients [1]
Summary
Hemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of muscles of facial expression which is innervated by the facial nerve. The etiology of hemifacial spasm is categorized into two types: primary and secondary. Repetitive brief contractions started unilateral in the orbicularis oculi which lead to closure of the eye. These contractions are always associated with eyebrow elevation which is called the other Babinski sign. These contractions spread to other facial muscles. Hemifacial spasm is a chronic condition where the best treatment modality has not been determined. Botulinum toxin remains the most popular treatment modality, but new oral pharmacotherapy and microsurgical decompression surgeries play an important role [1]
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