Abstract
Hemifacial spasm (HFS) is a chronic movement disorder which presents as clonic and/or tonic facial muscle contractions frequently accompanied by many other sensory (visual or auditory disturbances, pain), motor (facial weakness, trismus, bruxism, dysarthria) and/or autonomic (lacrimation, salivation) symptoms. The aim of the study was to assess the occurrence of HFS non-motor and motor-related symptoms and their responsiveness to botulinum toxin type A (BTX-A) therapy. 56 HFS patients were included in the open-label design study. Patients were examined three times: before BTX-A injection, and 2 and 12 weeks later. The occurrence of non-motor and motor-related symptoms was assessed by a special questionnaire, and the severity of HFS was rated by the Clinical Global Impression-Severity scale (CGI-S) and depression symptoms by the Beck Depression Inventory (BDI). Over 81% of the patients before BTX-A therapy reported HFS non-motor and motor-related symptoms. Almost 50% of the patients reported more than three symptoms. The most frequent symptoms were: tearing (44.5%), eye irritation (39.3%), facial paraesthesia (26.8%) and hearing of a “clicking” sound (25.0%). 2 weeks after BTX-A injection 75% of the patients did not report any symptoms and 20% reported only one or two. 3 months later the number of symptoms had increased again, with 57% of patients reporting at least one. The number of HFS non-motor and other symptoms did not correlate with the patients’ age, disease duration and the presence of neuro-vascular conflict, but were positively correlated with the CGI-S and BDI scores. This study showed that muscle contractions in HFS patients are commonly accompanied by non-motor and other motor-related symptoms and most of them are reduced following BTX-A treatment.
Similar content being viewed by others
References
Astarloa R, Morales B, Penafiel N, Rbano J, de Yebenes JG (1991) Craniocervical dystonia and facial hemispasm: clinical and pharmacological characteristics of 52 patients. Rev Clin Esp 189:320–324
Auger RG, Whisnant JP (1990) Hemifacial spasm in Rochester and Olmsted County, Minnesota, 1960–1984. Arch Neurol 47(11):1233–1234
Berardelli A, Rothwell JC, Day BL, Marsden CD (1985) Pathophysiology of blepharospasm and oromandibular dystonia. Brain 108(Pt 3):593–608
Bielamowicz S, Ludlow CL (2000) Effects of botulinum toxin on pathophysiology in spasmodic dysphonia. Ann Otol Rhinol Laryngol 109(2):194–203
Currà A, Trompetto C, Abbruzzese G, Berardelli A (2004) Central effects of botulinum toxin type A: evidence and supposition. Mov Disord 19(Suppl 8):S60–S64
Defazio G, Martino D, Aniello MS, Masi G, Logroscino G, Manobianca G, La Stilla M, Livrea P (2003) Influence of age on the association between primary hemifacial spasm and arterial hypertension. J Neurol Neurosurg Psychiatry 74(7):979–981
Eleopra R, Tugnoli V, Caniatti L, De Grandis D (1996) Botulinum toxin treatment in the facial muscles of humans: evidence of an action in untreated near muscles by peripheral local diffusion. Neurology 46(4):1158–1160
Frei K, Truong DD, Dressler D (2006) Botulinum toxin therapy of hemifacial spasm: comparing different therapeutic preparations. Eur J Neurol 13(Suppl 1):30–35
Frueh BR, Preston RA, Musch DC (1990) Facial nerve injury and hemifacial spasm. Am J Ophthalmol 110(4):421–423
Gardner WJ (1968) Trigeminal neuralgia. Clin Neurosurg 15:1–15
Garner CG, Straube A, Witt TN, Gasser T, Oertel WH (1993) Time course of distant effects of local injections of botulinum toxin. Mov Disord 8(1):33–37
Huang YC, Fan JY, Ro LS et al (2009) Validation of a Chinese version of disease specific quality of life scale (HFS-36) for hemifacial spasm in Tajwan. Health Qual Life Outcomes 7:104
Jankovic J (2004) Botulinum toxin in clinical practice. J Neurol Neurosurg Psychiatry 75(7):951–957
Jitpimolmard S, Tiamkao S, Laopaiboon M (1998) Long term results of botulinum toxin type A in the treatment of hemifacial spasm: a report of 175 cases. J Neurol Neurosurg Psychiatry 64:751–757
Kanovský P, Streitová H, Dufek J, Znojil V, Daniel P, Rektor I (1998) Change in lateralization of the P22/N30 cortical component of median nerve somatosensory evoked potentials in patients with cervical dystonia after successful treatment with botulinum toxin A. Mov Disord 13(1):108–117
Kuroki A, Moller AR (1994) Facial nerve demyelination and vascular compression are both needed to induce facial hyperactivity: a study in rats. Acta Neurochir 126:149–157
Lange DJ, Rubin M, Greene PE, Kang UJ, Moskowitz CB, Brin MF, Lovelace RE, Fahn S (1991) Distant effects of locally injected botulinum toxin: a double-blind study of single fiber EMG changes. Muscle Nerve 14(7):672–675
Martinelli P, Giuliani S, Ippoliti M (1992) Hemifacial spasm due to peripheral injury of facial nerve: a nuclear syndrome. Mov Disord 7:181–184
Maurice-Williams RS (1973) Tic convulsif: the association of trigeminal neuralgia and hemifacial spasm. Postgrad Med J 49(576):742–745
Moller AR (1991) Interaction between the blink reflex and the abnormal muscle response in patients with hemifacial spasm: results of intraoperative recordings. J Neurol Sci 101:114–123
Moller AR, Jannetta PJ (1984) On the origin of synkinesis in hemifacial spasm: result of intracranial recording. J Neurosurg 61:569–576
Moller MB, Moller AR (1985) Loss of auditory function in microvascular decompression for hemifacial spasm. J Neurosurg 63:17–20
Naumann M, Jost W (2004) Botulinum toxin treatment of secretory disorders. Mov Disord 19(Suppl 8):S137–S141
Nielsen VK (1984) Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology 34:418–426
Oliveira LD, Cardoso F, Vargas AP (1999) Hemifacial spasm and arterial hypertension. Mov Disord 14(5):832–835
Reimer J, Gilg K, Karow A et al (2005) Health-related quality of life in blepharospasm or hemifacial spasm. Acta Neurol Scand 11:64–70
Schnider P, Birner P, Moraru E, Au E (1999) Long-term treatment with botulinum toxin: dosage treatment schedules and costs. Wien Klin Wochenschr 111:59–65
Tan EK, Chan LL, Koh KK (2004a) Coexistent blepharospasm and hemifacial spasm: overlapping pathophysiologic mechanism? J Neurol Neurosurg Psychiatry 75(3):494–496
Tan EK, Fook-Chong S, Lum SY et al (2004b) Botulinum toxin improves quality of life in hemifacial spasm: validation of a questionnaire (HFS-30). J Neurol Scien 219:151–155
Tan EK, Lum SY, Fook-Chong S, Chan LL, Gabriel C, Lim L (2005) Behind the facial twitch: depressive symptoms in hemifacial spasm. Parkinsonism Relat Disord 11(4):241–245
Tan EK, Hameed S, Fook-Chong S et al (2008) Treatment outcomes correlates with knowledge of disease in hemifacial spasm. Clin Neurol Neurosurg 110:813–817
Valls-Sole J, Tolosa ES, Ribera G (1991) Neurophysiological observations on the effects of botulinum toxin treatment in patients with dystonic blepharospasm. J Neurol Neurosurg Psychiatry 54(4):310–313
Wang A, Jankowic J (1998) Hemifacial spasm: clinical findings and treatment. Muscle Nerve 21:1740–1747
Wiegand H, Erdmann G, Wellhöner HH (1976) 125I-labelled botulinum A neurotoxin: pharmacokinetics in cats after intramuscular injection. Naunyn Schmiedebergs Arch Pharmacol 292(2):161–165
Wilkins RH (1991) Hemifacial spasm: a review. Surg Neurol 36:251–277
Wilkins RH (1993) Hemifacial spasm and other facial nerve dysfunction syndromes. In: Barrow DL (ed) Surgery of the cranial nerves of the posterior fossa. American Association of Neurological Surgeons, pp 221–233
Acknowledgments
This study was supported by grant K/ZDS/000617 from the Jagiellonian University Medical College.
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rudzińska, M., Wójcik, M. & Szczudlik, A. Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy. J Neural Transm 117, 765–772 (2010). https://doi.org/10.1007/s00702-010-0416-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00702-010-0416-5