Pregabalin as add-on treatment to botulinum toxin in idiopathic hemifacial spasm

Abstract

Botulinum toxin (BTX) is the medical therapy of choice in hemifacial spasm (HFS). However, in some patients, its therapeutic effect is insufficient. ### Patient 1. A 64-year-old man with a 10-year history of left-sided HFS was treated with BTX over a period of 6 years with good results. However, in the last 2 years the spasms were never sufficiently relieved by BTX. The patient felt significantly impaired, but declined to undergo neurosurgical intervention. The EDB test showed a decrease in the CMAP amplitude of 60%. Without changing the BTX regime, pregabalin (initially 75 mg/day increased every 5 days by 75 mg to 150 mg twice daily) was added for a 1-month trial period in the absence of adverse effects. The HFS subsided gradually. After discontinuation of the drug at the end of the trial period, the symptoms recurred after <4 weeks. Rechallenge with pregabalin alone at a dosage of 300 mg/day over 4 weeks improved HFS but did …