Experience in treating hemifacial spasm combined with facial nerve neuropathy. A clinical case report

Abstract

Hemifacial spasm (HFS) is a spontaneous paroxysmal contraction of the facial muscles caused by the presence of a neurovascular conflict between the root of the facial ner ve and the vessel of the base of the posterior cranial fossa. With prolonged duration, patients may develop facial nerve neuropathy. The aim of this article was to describe the treatment principles for patients with HFS in the presence of facial nerve neuropathy symptoms. The paper presents a clinical case of a female patient who had been experiencing HFS symptoms for a long time, accompanied by symptoms of facial nerve neuropathy (synkinetic movements, facial asymmetry, myokymia, and facial muscle contractions). Despite multiple courses of botulinum toxin therapy (with various preparations), the effectiveness of the treatment decreased. The patient underwent microvascular decompression, after which the HFS symptoms regressed, and the courses of botulinum toxin injections were continued to reduce the symptoms of facial nerve neuropathy. Conclusion: In cases of HFS with accompanying symptoms of facial nerve neuropathy (synkinetic movements, facial asymmetry, myokymia, and facial muscle contractions) of prolonged duration, it is necessary to eliminate the neurovascular conflict first and subsequently treat these symptoms using botulinum toxin type A.