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McEntire CRS, Chwalisz BK. Cranial nerve involvement, visual complications and headache syndromes in Lyme disease. Curr Opin Ophthalmol 2024; 35:265-271. [PMID: 38518069 DOI: 10.1097/icu.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the visual manifestations and cranial neuropathies seen in Lyme disease. RECENT FINDINGS Lyme facial palsy remains the most common manifestation of Lyme neuroborreliosis. Recent investigations show likely evidence of vagal involvement in Lyme disease. SUMMARY The literature on Lyme neuroborreliosis continues to evolve. Lyme disease can affect nearly any cranial nerve in addition to causing various headache syndromes. The most common manifestation is Lyme disease facial palsy, occurring in up to 5-10% of patients with documented Lyme disease. Headache syndromes are common in the context of facial palsy but can occur in isolation, and more specific headache syndromes including trigeminal and geniculate neuralgias can occur rarely. Signs and symptoms indicative of vestibulocochlear nerve involvement are relatively common, although it could be that these represent other vestibular involvement rather than a specific cranial neuropathy. Optic neuritis is a controversial entity within Lyme disease and is likely overdiagnosed, but convincing cases do exist. Physicians who see any cranial neuropathy, including optic neuritis, in an endemic area can consider Lyme disease as a possible cause.
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Affiliation(s)
- Caleb R S McEntire
- Massachusetts General Hospital-Harvard Medical School
- Brigham and Women's Hospital-Harvard Medical School, Department of Neurology
| | - Bart K Chwalisz
- Massachusetts General Hospital-Harvard Medical School
- Massachusetts Eye and Ear-Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts, USA
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Mäkelä E, Venesvirta H, Ilves M, Lylykangas J, Rantanen V, Uusitalo H, Verho J, Vehkaoja A, Lekkala J, Surakka V, Rautiainen M. Electrically Induced Blink for the Prevention of Ocular Symptoms and Blurred Vision in Patients With Acute Facial Nerve Palsy. EAR, NOSE & THROAT JOURNAL 2024; 103:NP294-NP300. [PMID: 34714168 DOI: 10.1177/01455613211048576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Facial nerve palsy causes blurred vision and ocular discomfort due to deficits in blinking and eye closure. The objective of this study was to determine whether eye-blinks could be elicited by electrical stimulation and whether electrically induced blink would have an effect on the visual acuity and ocular symptoms in patients with acute facial nerve palsy. Methods: The zygomatic branch of the facial nerve of fifteen participants with acute facial nerve palsy was electrically stimulated in order to elicit a blink. In successful cases, the participant proceeded with a two-hour TV watching session in which an electrically induced blink was delivered every 5 seconds. The control condition consisted of an otherwise similar TV watching session without electrically induced blinking. Subjective ocular symptoms were evaluated with a Dry Eye Questionnaire and visual acuity was assessed with a Logarithm of the Minimum Angle of Resolution (LogMAR) chart before and after both sessions. Results: The stimulation produced a blink in 8 participants (53%). The visual acuity in the affected eye decreased during the control session, whereas no significant change occurred during the stimulation session. The ocular symptoms were significantly reduced during the stimulation session. Conclusions: Electrically elicited blink is a promising method for reducing the eye symptoms in individuals with acute facial nerve palsy.
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Affiliation(s)
- Eeva Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hanna Venesvirta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mirja Ilves
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Jani Lylykangas
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ville Rantanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Uusitalo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Ophthalmology, Tampere University Hospital, Tampere, Finland
| | - Jarmo Verho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jukka Lekkala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Veikko Surakka
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Markus Rautiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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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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Kishimoto‐Urata M, Urata S, Nishijima H, Baba S, Fujimaki Y, Kondo K, Yamasoba T. Predicting synkinesis caused by Bell's palsy or Ramsay Hunt syndrome using machine learning-based logistic regression. Laryngoscope Investig Otolaryngol 2023; 8:1189-1195. [PMID: 37899861 PMCID: PMC10601547 DOI: 10.1002/lio2.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To investigate whether machine learning (ML)-based algorithms, namely logistic regression (LR), random forest (RF), k-nearest neighbor (k-NN), and gradient-boosting decision tree (GBDT), utilizing early post-onset parameters can predict facial synkinesis resulting from Bell's palsy or Ramsay Hunt syndrome more accurately than the conventional statistics-based LR. Methods This retrospective study included 362 patients who presented to a facial palsy outpatient clinic. Median follow-up of synkinesis-positive and -negative patients was 388 (range, 177-1922) and 198 (range, 190-3021) days, respectively. Electrophysiological examinations were performed, and the rate of synkinesis in Bell's palsy and Ramsay Hunt syndrome was evaluated. Sensitivity and specificity were assessed using statistics-based LR; and electroneurography (ENoG) value, the difference in the nerve excitability test (NET), and scores of the subjective Yanagihara scaling system were evaluated using early post-onset parameters with ML-based LR, RF, k-NN, and GBDT. Results Synkinesis rate in Bell's palsy and Ramsay Hunt syndrome was 20.2% (53/262) and 40.0% (40/100), respectively. Sensitivity and specificity obtained with statistics-based LR were 0.796 and 0.806, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.87. AUCs measured using ML-based LR of "ENoG," "difference in NET," "Yanagihara," and all three components ("all") were 0.910, 0.834, 0.711, and 0.901, respectively. Conclusion ML-based LR model shows potential in predicting facial synkinesis probability resulting from Bell's palsy or Ramsay Hunt syndrome and has comparable reliability to the conventional statistics-based LR. Level of Evidence 3.
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Affiliation(s)
- Megumi Kishimoto‐Urata
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shinji Urata
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hironobu Nishijima
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shintaro Baba
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoko Fujimaki
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kenji Kondo
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
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Yamakawa K, Nishijima H, Kubota A, Naruse H, Baba S, Fujimaki Y, Kondo K, Toda T, Yamasoba T. Clinical and electrophysiological findings of facial palsy in a case of hereditary gelsolin amyloidosis. Auris Nasus Larynx 2023; 50:305-308. [PMID: 35241298 DOI: 10.1016/j.anl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Hereditary gelsolin amyloidosis (HGA) is an autosomal dominant systemic amyloidosis, characterized by cranial and sensory peripheral neuropathy, corneal lattice dystrophy, and cutis laxa. We report a case of HGA presenting with bilateral facial palsy. A 70-year-old Japanese man presented with slowly progressive bilateral facial palsy and facial twitching, which had started in his 40s. His mother also had the same symptoms due to an unknown cause but rest of the family did not. He showed incomplete facial palsy with no frontal muscle movement and partial movement of the orbicularis oris and orbicularis oculi muscles. The patient showed no synkinesis. Electroneurography revealed symmetric low compound motor action potential amplitude of the orbicularis oris muscle, and a nerve excitability test showed a symmetric increase in the response threshold. Despite the partial voluntary movement of the orbicularis oculi muscle, bilateral blink reflexes were absent. He also showed facial spasms after contraction of the orbicularis oris muscle. Genetic testing revealed a heterozygous c.640G>A mutation (p. Asp214Asn); therefore, the patient was diagnosed with HGA. HGA related facial palsy showed moderate bilateral, upper blanch-dominant axonal degeneration of the facial nerve without reinnervation, and trigeminal nerve neuropathy.
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Affiliation(s)
- Kaoru Yamakawa
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan.
| | | | - Akatsuki Kubota
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Hiroya Naruse
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shintaro Baba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
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Rodríguez Martínez EA, Polezhaeva O, Marcellin F, Colin É, Boyaval L, Sarhan FR, Dakpé S. DeepSmile: Anomaly Detection Software for Facial Movement Assessment. Diagnostics (Basel) 2023; 13:diagnostics13020254. [PMID: 36673064 PMCID: PMC9858579 DOI: 10.3390/diagnostics13020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Facial movements are crucial for human interaction because they provide relevant information on verbal and non-verbal communication and social interactions. From a clinical point of view, the analysis of facial movements is important for diagnosis, follow-up, drug therapy, and surgical treatment. Current methods of assessing facial palsy are either (i) objective but inaccurate, (ii) subjective and, thus, depending on the clinician's level of experience, or (iii) based on static data. To address the aforementioned problems, we implemented a deep learning algorithm to assess facial movements during smiling. Such a model was trained on a dataset that contains healthy smiles only following an anomaly detection strategy. Generally speaking, the degree of anomaly is computed by comparing the model's suggested healthy smile with the person's actual smile. The experimentation showed that the model successfully computed a high degree of anomaly when assessing the patients' smiles. Furthermore, a graphical user interface was developed to test its practical usage in a clinical routine. In conclusion, we present a deep learning model, implemented on open-source software, designed to help clinicians to assess facial movements.
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Affiliation(s)
- Eder A. Rodríguez Martínez
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Correspondence: (E.A.R.M.); (S.D.); Tel.: +33-(0)-22-08-90-48 (E.A.R.M.)
| | - Olga Polezhaeva
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Faculty of Odontology, University of Reims Champagne-Ardenne, 51097 Reims, France
| | - Félix Marcellin
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
| | - Émilien Colin
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Maxillofacial Surgery, CHU Amiens-Picardie, 80000 Amiens, France
| | - Lisa Boyaval
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Faculty of Odontology, University of Reims Champagne-Ardenne, 51097 Reims, France
| | - François-Régis Sarhan
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Physiotherapy School, CHU Amiens-Picardie, 80000 Amiens, France
| | - Stéphanie Dakpé
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Maxillofacial Surgery, CHU Amiens-Picardie, 80000 Amiens, France
- Correspondence: (E.A.R.M.); (S.D.); Tel.: +33-(0)-22-08-90-48 (E.A.R.M.)
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Abstract
BACKGROUND Surgical intervention with Combined myectomy & neurectomy followed by functioning free muscle transplantation (FFMT) has been proposed to effectively resolve the problem of postparalytic facial synkinesis (PPFS) since 1985, and continues to be our standard-of-care. We aim to provide evidence that this surgical strategy is effective for treatment of synkinesis and smile quality. METHODS 103 patients with PPFS were investigated (1985-2020). They all underwent extensive removal of the synkinetic muscles and triggered facial nerve branches in the cheek, nose and neck regions, followed by gracilis FFMT for facial reanimation. Ninety-four patients with 50 Type II and 44 Type III PPFS patients, all of whom had at least one year of postoperative follow-up were included in the study. Patient's demographics, functional and aesthetic evaluations before and after surgery were collected. RESULTS In the yearly distribution of the facial paralysis reconstruction, the incidence of surgical intervention increased from 15% prior to 2012 up to 24% in the years after. Young adults (79%) and female patients (63%) were the dominant population. Results showed a significant improvement of the facial smile quality with more teeth visible while smiling, and a long-lasting decrease of facial synkinesis. Ninety six percent of patients did not require botulinum-A toxin injection after surgery. Revision surgery for secondary deformity was 53%. CONCLUSION Combined myectomy & neurectomy followed by FFMT for Type II and III synkinetic patients leads to promising and long-lasting results despite high revision rates. Refined techniques to decrease the revision rates are needed in the future.
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Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A. Dystonia, chorea, hemiballismus and other dyskinesias. Clin Neurophysiol 2022; 140:110-125. [PMID: 35785630 DOI: 10.1016/j.clinph.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Hyperkinesias are heterogeneous involuntary movements that significantly differ in terms of clinical and semeiological manifestations, including rhythm, regularity, speed, duration, and other factors that determine their appearance or suppression. Hyperkinesias are due to complex, variable, and largely undefined pathophysiological mechanisms that may involve different brain areas. In this chapter, we specifically focus on dystonia, chorea and hemiballismus, and other dyskinesias, specifically, levodopa-induced, tardive, and cranial dyskinesia. We address the role of neurophysiological studies aimed at explaining the pathophysiology of these conditions. We mainly refer to human studies using surface and invasive in-depth recordings, as well as spinal, brainstem, and transcortical reflexology and non-invasive brain stimulation techniques. We discuss the extent to which the neurophysiological abnormalities observed in hyperkinesias may be explained by pathophysiological models. We highlight the most relevant issues that deserve future research efforts. The potential role of neurophysiological assessment in the clinical context of hyperkinesia is also discussed.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Josep Valls-Solè
- Institut d'Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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Gat L, Gerston A, Shikun L, Inzelberg L, Hanein Y. Similarities and disparities between visual analysis and high-resolution electromyography of facial expressions. PLoS One 2022; 17:e0262286. [PMID: 35192638 PMCID: PMC8863227 DOI: 10.1371/journal.pone.0262286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Computer vision (CV) is widely used in the investigation of facial expressions. Applications range from psychological evaluation to neurology, to name just two examples. CV for identifying facial expressions may suffer from several shortcomings: CV provides indirect information about muscle activation, it is insensitive to activations that do not involve visible deformations, such as jaw clenching. Moreover, it relies on high-resolution and unobstructed visuals. High density surface electromyography (sEMG) recordings with soft electrode array is an alternative approach which provides direct information about muscle activation, even from freely behaving humans. In this investigation, we compare CV and sEMG analysis of facial muscle activation. We used independent component analysis (ICA) and multiple linear regression (MLR) to quantify the similarity and disparity between the two approaches for posed muscle activations. The comparison reveals similarity in event detection, but discrepancies and inconsistencies in source identification. Specifically, the correspondence between sEMG and action unit (AU)-based analyses, the most widely used basis of CV muscle activation prediction, appears to vary between participants and sessions. We also show a comparison between AU and sEMG data of spontaneous smiles, highlighting the differences between the two approaches. The data presented in this paper suggests that the use of AU-based analysis should consider its limited ability to reliably compare between different sessions and individuals and highlight the advantages of high-resolution sEMG for facial expression analysis.
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Affiliation(s)
- Liraz Gat
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Gerston
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
- X-trodes, Herzelia, Israel
| | - Liu Shikun
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Lilah Inzelberg
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- X-trodes, Herzelia, Israel
- * E-mail:
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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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Murase N, Goto M, Kohara N, Kimura J. Sustained atypical myokymia of the abductor pollicis brevis with a focal slowing of the median nerve motor axons at the wrist. Clin Neurophysiol Pract 2020; 6:36-40. [PMID: 33490741 PMCID: PMC7808925 DOI: 10.1016/j.cnp.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/15/2020] [Accepted: 11/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We report a case of sustained atypical myokymia associated with short bursts of neuromyotonic discharges involving the abductor pollicis brevis (APB) muscle and describe a useful way of detecting a focal slowing involving a small number of median nerve motor fibers with a concentric needle using the filter setting for single fiber electromyography (EMG). METHODS AND RESULTS A 62-year-old woman developed right thumb twitches at regular interval of 1.7-3.3 s (0.6-0.3 Hz), which continued for more than four months. Muscle twitches remained the same during altered hand position, psychological stress, or sleep. A concentric needle inserted in the active zone of the APB muscle revealed myokymic bursts with a characteristic of neuromyotonic discharges. Inching study, stimulating at 5 mm increment along the median nerve and recording with a concentric needle using a filter setting for single fiber EMG, revealed a focal slowing of the motor fibers at a point 5-10 mm distal from the distal crease of the wrist, an entrapment site occasionally seen in the carpal tunnel syndrome. One injection of botulinum toxin type A eliminated the myokymia, which then recurred two and a half years later, showing less prominent muscle twitches. CONCLUSIONS Sustained atypical myokymia seen in our case represented bursts of neuromyotonic discharges originated from a focal demyelinating lesion involving a few median nerve motor fibers.
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Affiliation(s)
- Nagako Murase
- Department of Neurology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukoubata-cho, Fukakusa, Fushimi-ku, Kyoto City, Kyoto 612-8555, Japan
| | - Masahiro Goto
- Department of Neurology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukoubata-cho, Fukakusa, Fushimi-ku, Kyoto City, Kyoto 612-8555, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, 1-1, 2 cho-me, Minamimachi, Minatojima, Chuou-ku, Kobe City, Kobe 650-0047, Japan
| | - Jun Kimura
- Department of Neurology, Division of Clinical Neurophysiology, University of Iowa Health Center, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Using Artificial Intelligence to Measure Facial Expression following Facial Reanimation Surgery. Plast Reconstr Surg 2020; 146:1147-1150. [DOI: 10.1097/prs.0000000000007251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carrilho PEM, Dos Santos MBM. Focal Muscle Spasms after Thoracic Spine Surgery for Schwannoma: The Twitching Scar. J Mov Disord 2020; 13:168-170. [PMID: 32498501 PMCID: PMC7280937 DOI: 10.14802/jmd.20017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Paulo Eduardo Mestrinelli Carrilho
- Neurology and Neurosurgery Discipline of Medicine School, State University of West Paraná (Unioeste), Cascavel, Paraná, Brazil.,Neuroclinica Cascavel, Paraná, Brazil
| | - Marcius Benigno Marques Dos Santos
- Neurology and Neurosurgery Discipline of Medicine School, State University of West Paraná (Unioeste), Cascavel, Paraná, Brazil.,Neuroclinica Cascavel, Paraná, Brazil
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Grippe T, Cunha NSCD, BrandÃo PRDP, Fernandez RNM, Cardoso FEC. How can neurophysiological studies help with movement disorders characterization in clinical practice? A review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:512-522. [PMID: 32901697 DOI: 10.1590/0004-282x20190195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neurophysiological studies are ancillary tools to better understand the features and nature of movement disorders. Electromyography (EMG), together with electroencephalography (EEG) and accelerometer, can be used to evaluate a hypo and hyperkinetic spectrum of movements. Specific techniques can be applied to better characterize the phenomenology, help distinguish functional from organic origin and assess the most probable site of the movement generator in the nervous system. OBJECTIVE We intend to provide an update for clinicians on helpful neurophysiological tools to assess movement disorders in clinical practice. METHODS Non-systematic review of the literature published up to June 2019. RESULTS A diversity of protocols was found and described. These include EMG analyses to define dystonia, myoclonus, myokymia, myorhythmia, and painful legs moving toes pattern; EMG in combination with accelerometer to study tremor; and EEG-EMG to study myoclonus. Also, indirect measures of cortical and brainstem excitability help to describe and diagnose abnormal physiology in Parkinson's disease, atypical parkinsonism, dystonia, and myoclonus. CONCLUSION These studies can be helpful for the diagnosis and are usually underutilized in neurological practice.
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Affiliation(s)
- Talyta Grippe
- Centro Universitário de Brasília, Faculdade de Medicina, Brasília DF, Brazil.,Hospital de Base do Distrito Federal, Departamento de Neurologia, Brasília DF, Brazil
| | | | | | | | - Francisco Eduardo Costa Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil
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15
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Change of Eyelid Parameters in Patients With Marin-Amat Syndrome. Ophthalmic Plast Reconstr Surg 2020; 36:298-301. [DOI: 10.1097/iop.0000000000001538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Inzelberg L, David-Pur M, Gur E, Hanein Y. Multi-channel electromyography-based mapping of spontaneous smiles. J Neural Eng 2020; 17:026025. [DOI: 10.1088/1741-2552/ab7c18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Wyffels ML, Ray BB, Laurita JT, Zbib N, Bachour K, Glass GE, Stotland MA. Impact of Glabellar Paralysis on Facial Expression of Emotion. Aesthet Surg J 2020; 40:430-436. [PMID: 31034024 DOI: 10.1093/asj/sjz094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many prospective patients remain wary of the effects that glabellar muscle paralysis may have on their ability to normally communicate emotion with their face. OBJECTIVE We undertook a direct empirical test of the effects of glabellar onabotulinum toxin type A injections on the ability to convey 6 universally recognized facial expressions of emotion. METHODS Fifty-two female subjects ("expressors") were recorded on hidden camera while viewing video clips intended as a mood induction procedure that stimulates the 6 cardinal emotions (amusement, anger, disgust, fear, sadness, surprise). The subjects were then injected with 25 units of onabotulinum toxin A in the glabellar region. The subjects returned 1 month later and were again recorded while being spontaneously induced to express emotion. All video clips from both time periods from the 10 maximal expressors were extracted and shown to a group of 31 "perceivers" who rated the facial expressions for intensity (Likert 1-7) and identity of emotion (percent correct emotion identified). RESULTS Glabellar paralysis significantly diminished mean perceived intensity of anger (50.4% relative reduction, P < 0.001) and surprise (20.6% relative reduction, P < 0.001). The mean intensity of disgust increased (39.0%, P < 0.001). Importantly, however, glabellar paralysis did not result in a significant change in observers' ability to discern provoked cardinal emotions. CONCLUSIONS We believe these findings provide a measure of reassurance to patients and their providers that the use of onabotulinum toxin A to paralyze the glabellar musculature for aesthetic purposes may not pose a meaningful risk to the overall ability to express emotion during social interaction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Belinda B Ray
- Center for Shared Decision Making, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Jason T Laurita
- Department of Orthopedic Surgery, Oregon Health and Sciences University, Portland, OR
| | - Natalia Zbib
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Graeme E Glass
- Division of Plastic and Craniofacial Surgery, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mitchell A Stotland
- Division of Plastic and Craniofacial Surgery, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar
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18
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Faris C, Tessler O, Heiser A, Hadlock T, Jowett N. Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation. JAMA FACIAL PLAST SU 2019; 20:480-487. [PMID: 30178066 DOI: 10.1001/jamafacial.2018.0866] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The severity of a health state may be quantified using health utility measures. The utility of flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome with synkinesis may be challenging to discern from photographs alone. Objective To determine the societal health utility of flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, and post-facial reanimation using standard video. Design, Setting, and Participants This survey study was conducted at the Massachusetts Eye and Ear and the Harvard Decision Science Laboratory from June 14, 2017, to August 3, 2017. Healthy adult naïve observers were recruited through advertising in the Cambridge, Massachusetts, area. Participants (n = 298) completed the web-based, interactive survey in person. The survey comprised clinical vignettes consisting of symptom summaries, videos, and pictures depicting 5 health states. Main Outcomes and Measures Adult naïve observers ranked the utility of 5 randomized health states (flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, post-facial reanimation, monocular blindness, and binocular blindness) according to the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) measures. Standard videos of patients' facial function were used. Results In total, 377 naïve observers were recruited and completed the survey in its entirety. Of the 377 participants, 298 (79.0%) were included for analysis. Among the 298 participants, 151 (50.7%) were female, 146 (49.0%) were male, with a mean (SD) age of 33.0 (15.1) years. No differences in health utility scores (SD) were observed between flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome (VAS: 0.598 [0.213] vs 0.629 [0.207]; SG: 0.714 [0.245] vs 0.748 [0.237]; TTO: 0.716 [0.248] vs 0.741 [0.247]). Both health states rated substantially worse than monocular blindness (VAS: 0.691 [0.212]; SG: 0.817 [0.204]; TTO: 0.826 [0.196]) and post-facial reanimation (VAS: 0.742 [0.189]; SG: 0.833 [0.206]; TTO: 0.838 [0.19]). Conclusions and Relevance Health utility scores for flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome appeared to be equivalent and worse than that for monocular blindness, whereas scores for post-facial reanimation were substantially higher than the scores for the 2 facial movement disorders. These findings may provide insights into the societal advantages of facial reanimation surgery. Level of Evidence NA.
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Affiliation(s)
- Callum Faris
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Head and Neck Surgery, Tübingen University, Tübingen, Germany
| | - Oren Tessler
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Tessa Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Nate Jowett
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
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Paradoxical Prominence of Nasolabial Fold as a Sign of Aberrant Facial Nerve Regeneration: The Alam’s Sign. Ophthalmic Plast Reconstr Surg 2019; 35:408-409. [DOI: 10.1097/iop.0000000000001398] [Citation(s) in RCA: 2] [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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20
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21
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22
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Trigeminal Hyperexcitability in Idiopathic Intracranial Hypertension: A Blink Reflex Study. J Clin Neurophysiol 2018; 35:408-414. [PMID: 30024454 DOI: 10.1097/wnp.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare blink reflex examination findings in patients with idiopathic intracranial hypertension (IIH) with migraineurs and controls and to investigate the role of blink reflex data in the follow-up by evaluating their relationship with clinical symptoms. METHODS We included 23 patients with IIH, 15 migraineurs, and 16 controls. Blink reflex was studied with bilateral paired stimulations, and the 2R2/1R2 and 2R2c/1R2c area ratios, 1R2, 2R2, 1R2c, and 2R2c latencies were compared (R2:ipsilateral R2 response, R2c:contralateral R2 response). RESULTS 2R2/1R2 area ratios at 200, 300, and 500 ms interstimulus intervals were significantly higher in the IIH group compared with the controls, and significantly higher 2R2/1R2 area ratio at 200 ms interstimulus interval was also detected in the IIH group compared with the migraine group. Significantly shorter 2R2 latencies were found at 500 and 800 ms interstimulus intervals in IIH group compared with the migraine group and controls. Significantly higher 2R2/1R2 area ratios at 500, 800 ms, and 2R2c/1R2c area ratios at 300, 500, and 800 ms were detected in patients with IIH in remission compared with patients with attacks. CONCLUSIONS The significant increase in R2 recovery rates in patients with IIH in remission suggests that there is an increased excitability in the trigeminal pathways. Our findings may provide a new perspective for IIH mechanism related to trigeminal hyperexcitability and evaluating new management strategies.
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Variability of facial movements in relation to sexual dimorphism and age: three-dimensional geometric morphometric study. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2018; 69:110-117. [PMID: 29970227 DOI: 10.1016/j.jchb.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
The aim of this study was to introduce suitable imaging technique and analytical methods for a detailed description of the facial movements in relation to sexual dimorphism and age in adult individuals. Removing of size factor from the analysis, we hypothesised that there will be no significant intersexual difference in facial mobility. We assume facial movements to be more pronounced in the older age category due to increasing the facial surface. We have compared five facial movements - raising eyebrows, closing eyes, pursing of the lips, inflating of the cheeks and smile - in relation to neutral expression of the human face. The material sample comprised three-dimensional facial surface models of healthy adult individuals of the Czech nationality (63 females, 58 males). Methods of geometric morphometry and multivariate statistics were used. Local tissue motion due to facial movements was expressed using colour-coded maps. The movement showing significant intersexual difference was inflating of the cheeks. Ageing in both sexes has significantly influenced the facial mobility on average after 50 years of age. Changes related to senescence have occurred in eye closing, smile and inflating of the cheeks. An enlarged facial surface has been noted in the group of individuals belonging to the older age category, what is probably the result of increased manifestation of skin folds and wrinkles. This is related to the loss of skin elasticity and overall weakening of the underlying muscles, especially in the infraorbital and cheeks area.
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Abstract
Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.
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25
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Defazio G, Hallett M, Jinnah HA, Conte A, Berardelli A. Blepharospasm 40 years later. Mov Disord 2017; 32:498-509. [PMID: 28186662 DOI: 10.1002/mds.26934] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 01/04/2023] Open
Abstract
Forty years ago, C.D. Marsden proposed that blepharospasm should be considered a form of adult-onset focal dystonia. In the present paper, we provide a comprehensive overview of the findings regarding blepharospasm reported in the past 40 years. Although prolonged spasms of the orbicularis oculi muscles remain the clinical hallmark of blepharospasm, patients with blepharospasm may be characterized by various types of involuntary activation of periocular muscles. In addition to motor features, blepharospasm patients may also have nonmotor manifestations, including psychiatric, mild cognitive, and sensory disturbances. The various motor and nonmotor symptoms are not present in all patients, suggesting that blepharospasm is phenomenologically a heterogeneous condition. This emphasizes the need for tools for severity assessment that take into account both motor and nonmotor manifestations. The cause of blepharospasm remains elusive, but several lines of evidence indicate that blepharospasm is a multifactorial condition in which one, or several, as yet unknown genes together with epigenetic and environmental factors combine to reach the threshold of the disease. Although blepharospasm was originally believed to be solely a basal ganglia disorder, neurophysiological and neuroimaging evidence point to anatomical and functional involvement of several brain regions. The contribution of multiple areas has led to the hypothesis that blepharospasm should be considered as a network disorder, and this might reflect the varying occurrence of motor and nonmotor manifestations in blepharospasm patients. Despite advances in the aetiology and pathophysiology, treatment remains symptomatic. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro", University of Bari, Bari, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Hyder A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Antonella Conte
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
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Cross-Face Nerve Grafting with Infraorbital Nerve Pathway Protection: Anatomic and Histomorphometric Feasibility Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1037. [PMID: 27757349 PMCID: PMC5055015 DOI: 10.1097/gox.0000000000001037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022]
Abstract
Smiling is an important aspect of emotional expression and social interaction, leaving facial palsy patients with impaired social functioning and decreased overall quality of life. Although there are several techniques available for facial reanimation, staged facial reanimation using donor nerve branches from the contralateral, functioning facial nerve connected to a cross-face nerve graft (CFNG) is the only technique that can reliably reproduce an emotionally spontaneous smile. Although CFNGs provide spontaneity, they typically produce less smile excursion than when the subsequent free functioning muscle flap is innervated with the motor nerve to the masseter muscle. This may be explained in part by the larger number of donor motor axons when using the masseter nerve, as studies have shown that only 20% to 50% of facial nerve donor axons successfully cross the nerve graft to innervate their targets. As demonstrated in our animal studies, increasing the number of donor axons that grow into and traverse the CFNG to innervate the free muscle transfer increases muscle movement, and this phenomenon may provide patients with the benefit of improved smile excursion. We have previously shown in animal studies that sensory nerves, when coapted to a nerve graft, improve axonal growth through the nerve graft and improve muscle excursion. Here, we describe the feasibility of and our experience in translating these results clinically by coapting the distal portion of the CFNG to branches of the infraorbital nerve.
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Irmady K, Jabbari B, Louis ED. Arm Posturing in a Patient Following Stroke: Dystonia, Levitation, Synkinesis, or Spasticity? TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:353. [PMID: 26682091 PMCID: PMC4681881 DOI: 10.7916/d8222tbh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/03/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-stroke movement disorders occur in up to 4% of stroke patients. The movements can be complex and difficult to classify, which presents challenges when attempting to understand the clinical phenomenology and provide appropriate treatment. CASE REPORT We present a 64-year-old male with an unusual movement in the arm contralateral to his ischemic stroke. The primary feature of the movement was an involuntary elevation of the arm, occurring only when he was walking. DISCUSSION The differential diagnosis includes dystonia, spontaneous arm levitation, synkinesis, and spasticity. We discuss each of these diagnostic possibilities in detail.
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Affiliation(s)
- Krithi Irmady
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Bahman Jabbari
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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Experimental studies on the recovery processes from severe facial palsy and the development of its sequelae. Otol Neurotol 2015; 36:896-903. [PMID: 25871969 DOI: 10.1097/mao.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To experimentally elucidate the pathogenesis of inappropriate co-contraction of facially innervated muscles after severe facial palsy. METHODS Twenty-two guinea pigs with severe facial palsy induced by the interruption of the petrosal artery were used to follow up behavioral facial movement, including the degree of facial palsy and abnormal hyperkinetic facial movement of synkinesis and mass contracture. At the end of the follow-up, the evoked facial compound muscle action potential (evoked FCMP) and antidromically evoked facial nerve response (AFNR) were examined in a few typical cases with complete recovery and with incomplete recovery accompanied by synkinesis. After the follow-up, all animals were sacrificed for morphological studies, which consisted of a light-microscopic study (by Luxol fast blue and hematoxylin and eosin staining or toluidine blue staining) and/or an electron-microscopic study. RESULTS The initial sign of recovery was mass contracture or spasm. This condition continued for 2 weeks or more. As voluntary facial movement recovered, the mass contracture became unnoticeable. It could not be distinguished when the so-called synkinesis developed. Synkinesis usually developed during the recovery process from severe to moderate palsy, and synkinesis persisted or progressed once it appeared. Histologically, unmyelinated fibers were intermingled with myelinated fibers in an early stage of recovery with mass contracture. In the late stage with the development of synkinesis, however, such an intermingling of unmyelinated and myelinated axons was not observed. In this stage, axons became well myelinated, but they were irregular in shape in cases with synkinesis. Especially, axons irregularly ran at the level of the G1 (at the region of the second genu) segment, and bifurcated axons were sporadically found. The axon count had a tendency to increase toward the periphery. AFNR was not detected, although evoked FCMP could be clearly detected in cases with synkinesis. CONCLUSION Misguidance of regenerated axons is an important cause of facial synkinesis in the ischemia-induced facial palsy model. Ephaptic transmission between unmyelinated and myelinated axons is also likely to be responsible for mass contracture manifested in the early stage of the recovery process.
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Placheta E, Wood MD, Lafontaine C, Frey M, Gordon T, Borschel GH. Macroscopic in vivo imaging of facial nerve regeneration in Thy1-GFP rats. JAMA FACIAL PLAST SU 2015; 17:8-15. [PMID: 25317544 DOI: 10.1001/jamafacial.2014.617] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Facial nerve injury leads to severe functional and aesthetic deficits. The transgenic Thy1-GFP rat is a new model for facial nerve injury and reconstruction research that will help improve clinical outcomes through translational facial nerve injury research. OBJECTIVE To determine whether serial in vivo imaging of nerve regeneration in the transgenic rat model is possible, facial nerve regeneration was imaged under the main paradigms of facial nerve injury and reconstruction. DESIGN, SETTING, AND PARTICIPANTS Fifteen male Thy1-GFP rats, which express green fluorescent protein (GFP) in their neural structures, were divided into 3 groups in the laboratory: crush-injury, direct repair, and cross-face nerve grafting (30-mm graft length). The distal nerve stump or nerve graft was predegenerated for 2 weeks. The facial nerve of the transgenic rats was serially imaged at the time of operation and after 2, 4, and 8 weeks of regeneration. The imaging was performed under a GFP-MDS-96/BN excitation stand (BLS Ltd). INTERVENTION OR EXPOSURE Facial nerve injury. MAIN OUTCOME AND MEASURE Optical fluorescence of regenerating facial nerve axons. RESULTS Serial in vivo imaging of the regeneration of GFP-positive axons in the Thy1-GFP rat model is possible. All animals survived the short imaging procedures well, and nerve regeneration was followed over clinically relevant distances. The predegeneration of the distal nerve stump or the cross-face nerve graft was, however, necessary to image the regeneration front at early time points. Crush injury was not suitable to sufficiently predegenerate the nerve (and to allow for degradation of the GFP through Wallerian degeneration). After direct repair, axons regenerated over the coaptation site in between 2 and 4 weeks. The GFP-positive nerve fibers reached the distal end of the 30-mm-long cross-face nervegrafts after 4 to 8 weeks of regeneration. CONCLUSIONS AND RELEVANCE The time course of facial nerve regeneration was studied by serial in vivo imaging in the transgenic rat model. Nerve regeneration was followed over clinically relevant distances in a small number of experimental animals, as they were subsequently imaged at multiple time points. The Thy1-GFP rat model will help improve clinical outcomes of facial reanimation surgery through improving the knowledge of facial nerve regeneration after surgical procedures. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Eva Placheta
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthew D Wood
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Lafontaine
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manfred Frey
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Tessa Gordon
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada4Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada5I
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30
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Robinson LR. How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions. Muscle Nerve 2015; 52:321-33. [DOI: 10.1002/mus.24709] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence R. Robinson
- Division of Physical Medicine and Rehabilitation; University of Toronto, Sunnybrook Health Sciences Centre; H391, 2075 Bayview Avenue Toronto Ontario M4N 3M5
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Enhancement of facial nerve motoneuron regeneration through cross-face nerve grafts by adding end-to-side sensory axons. Plast Reconstr Surg 2015; 135:460-471. [PMID: 25626793 DOI: 10.1097/prs.0000000000000893] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND In unilateral facial palsy, cross-face nerve grafts are used for emotional facial reanimation. Facial nerve regeneration through the grafts takes several months, and the functional results are sometimes inadequate. Chronic denervation of the cross-face nerve graft results in incomplete nerve regeneration. The authors hypothesize that donor axons from regional sensory nerves will enhance facial motoneuron regeneration, improve axon regeneration, and improve the amplitude of facial muscle movement. METHODS In the rat model, a 30-mm nerve graft (right common peroneal nerve) was used as a cross-face nerve graft. The graft was coapted to the proximal stump of the transected right buccal branch of the facial nerve and the distal stumps of the transected left buccal and marginal mandibular branches. In one group, sensory occipital nerves were coapted end-to-side to the cross-face nerve graft. Regeneration of green fluorescent protein-positive axons was imaged in vivo in transgenic Thy1-green fluorescent protein rats, in which all neurons express green fluorescence. After 16 weeks, retrograde labeling of regenerated neurons and histomorphometric analysis of myelinated axons was performed. Functional outcomes were assessed with video analysis of whisker motion. RESULTS "Pathway protection" with sensory axons significantly enhanced motoneuron regeneration, as assessed by retrograde labeling, in vivo fluorescence imaging, and histomorphometry, and significantly improved whisker motion during video analysis. CONCLUSION Sensory pathway protection of cross-face nerve grafts counteracts chronic denervation in nerve grafts and improves regeneration and functional outcomes.
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Postparalysis facial synkinesis: clinical classification and surgical strategies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e320. [PMID: 25878931 PMCID: PMC4387142 DOI: 10.1097/gox.0000000000000283] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Postparalysis facial synkinesis (PPFS) can occur after any cause of facial palsy. Current treatments are still inadequate. Surgical intervention, instead of Botox and rehabilitation only, for different degrees of PPFS was proposed. Methods: Seventy patients (43 females and 27 males) with PPFS were enrolled since 1986. They were divided into 4 patterns based on quality of smile and severity of synkinesis. Data collection for clinically various presentations was made: pattern I (n = 14) with good smile but synkinesis, pattern II (n = 17) with acceptable smile but dominant synkinesis, pattern III (n = 34) unacceptable smile and dominant synkinesis, and pattern IV (n = 5) poor smile and synkinesis. Surgical interventions were based on patterns of PPFS. Selective myectomy and some cosmetic procedures were performed for pattern I and II patients. Extensive myectomy and neurectomy of the involved muscles and nerves followed by functioning free-muscle transplantation for facial reanimation in 1- or 2-stage procedure were performed for pattern III and many pattern II patients. A classic 2-stage procedure for facial reanimation was performed for pattern IV patients. Results: Minor aesthetic procedures provided some help to pattern I patients but did not cure the problem. They all had short follow-up. Most patients in patterns II (14/17, 82%) and III (34/34, 100%) showed a significant improvement of eye and smile appearance and significant decrease in synkinetic movements following the aggressively major surgical intervention. Nearly, all of the patients treated by the authors did not need repeated botulinum toxin A injection nor require a profound rehabilitation program in the follow-up period. Conclusions: Treatment of PPFS remains a challenging problem. Major surgical reconstruction showed more promising and long-lasting results than botulinum toxin A and/or rehabilitation on pattern III and II patients.
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Mancini P, De Seta D, Prosperini L, Nicastri M, Gabriele M, Ceccanti M, Sementilli G, Terella M, Bertoli GA, Filipo R, Inghilleri M. Prognostic factors of Bell's palsy: Multivariate analysis of electrophysiological findings. Laryngoscope 2014; 124:2598-605. [DOI: 10.1002/lary.24764] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Luca Prosperini
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Maria Nicastri
- Department of Sense Organs; University Sapienza; Rome Italy
| | - Maria Gabriele
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | | | - Maria Terella
- Department of Sense Organs; University Sapienza; Rome Italy
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Effect of endoscopic brow lift on contractures and synkinesis of the facial muscles in patients with a regenerated postparalytic facial nerve syndrome. Plast Reconstr Surg 2014; 133:121-129. [PMID: 24105091 DOI: 10.1097/01.prs.0000436834.19066.7c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the postparalytic facial nerve syndrome. The authors present an alternative surgical approach for improvement of periocular movement disorders in patients with postparalytic facial nerve syndrome. The authors proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input. METHODS Eleven patients (seven women and four men) with a mean age of 54 years (range, 33 to 85 years) and with postparalytic facial nerve syndrome underwent endoscopic brow lift under general anesthesia. Patients' preoperative condition was compared with their postoperative condition using a retrospective questionnaire. Subjects were also asked to compare the therapeutic effectiveness of endoscopic brow lift and botulinum toxin type A. RESULTS Mean follow-up was 52 months (range, 22 to 83 months). No intraoperative or postoperative complications occurred. During follow-up, patients and physicians observed an improvement of periorbital contractures and oculofacial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when botulinum toxin type A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect. CONCLUSIONS These findings suggest endoscopic brow lift as a promising additional treatment modality for the treatment of periocular postparalytic facial nerve syndrome-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical botulinum toxin type A administration could become a new therapeutic standard.
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Choi SI, Kim MW, Park DY, Huh R, Jang DH. Electrophysiologic investigation during facial motor neuron suppression in patients with hemifacial spasm: possible pathophysiology of hemifacial spasm: a pilot study. Ann Rehabil Med 2013; 37:839-47. [PMID: 24466519 PMCID: PMC3895524 DOI: 10.5535/arm.2013.37.6.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the pathophysiological mechanism of hemifacial spasm (HFS), we performed electrophysiological examinations, such as supraorbital nerve stimulation with orbicularis oris muscle recording and lateral spread tests, after suppressing the patient's central nervous system by administering intravenous diazepam. Methods Six patients with HFS were recruited. Supraorbital nerve stimulation with orbicularis oris muscle recording and the lateral spread test were performed, followed by intravenous application of 10 mg diazepam to achieve facial motor neuron suppression. Subsequently, we repeated the two electrophysiological experiments mentioned above at 10 and 20 minutes after the patients had received the diazepam intravenously. Results Orbicularis oris muscle responses were observed in all patients after supraorbital nerve stimulation and lateral spread tests. After the diazepam injection, no orbicularis oris muscle response to supraorbital nerve stimulation was observed in one patient, and the latencies of this response were evident as a slowing tendency with time in the remaining five patients. However, the latencies of the orbicularis oris muscle responses were observed consistently in all patients in the lateral spread test. Conclusion Our results suggest that ectopic excitation/ephaptic transmission contributes to the pathophysiological mechanisms of HFS. This is because the latencies of the orbicularis oris muscle responses in the lateral spread test were observed consistently in the suppressed motor neuron in our patients.
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Affiliation(s)
- Soo In Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Dong Yoon Park
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Ryoong Huh
- Department of Neurosurgery, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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Bonnet L, Magnin E, Comte A, Rumbach L. Hemifacial spasm revealing contralateral peripheral facial palsy. Rev Neurol (Paris) 2013; 169:1015-6. [PMID: 24120245 DOI: 10.1016/j.neurol.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/10/2012] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- L Bonnet
- Department of Neurology, J. Minjoz University Hospital, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
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Peña E. Treatment with botulinum toxin: An update. World J Neurol 2013; 3:29-41. [DOI: 10.5316/wjn.v3.i3.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is a potent toxin produced by the anaerobic bacterium clostridium botulinum. It causes flaccid, long-lasting, local and reversible paralysis. In addition, BoNT inhibits the secretion of the exocrine glands and could have properties in the control of pain. Thus, BoNT is useful in the treatment of many neuromuscular conditions where an increase of muscle tone is associated with the pathogenic mechanism. Furthermore, BoNT is recommended in the treatment of some hypersecretion disorders of the exocrine gland and could play a role in the treatment of migraine and other chronic pain conditions. In the BoNT therapy adverse effects are usually mild and reversible. However, repeated injections of BoNT can lead to the development of neutralizing antibodies that can subsequently inhibit the biological activity of the toxin. In this sense, many factors can influence the immunogenicity of the BoNT, such as product-related factors, the dose of BoNT used, the frequency of injection and the previous exposure to the toxin. In this review, we are going to discuss the current clinical applications of BoNT with a special focus on evidence, doses, injection technique and adverse effects for those applications more frequently used in neurology, namely spasticity, blepharospasm, hemifacial spasm, cervical dystonia and other focal dystonias, as well as chronic migraine, tremor, sialorrhea, facial palsy, neurogenic bladder and many other neurological condition.
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Hundeshagen G, Szameit K, Thieme H, Finkensieper M, Angelov D, Guntinas-Lichius O, Irintchev A. Deficient functional recovery after facial nerve crush in rats is associated with restricted rearrangements of synaptic terminals in the facial nucleus. Neuroscience 2013; 248:307-18. [DOI: 10.1016/j.neuroscience.2013.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/21/2013] [Accepted: 06/13/2013] [Indexed: 01/18/2023]
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Nicastri M, Mancini P, De Seta D, Bertoli G, Prosperini L, Toni D, Inghilleri M, Filipo R. Efficacy of Early Physical Therapy in Severe Bell’s Palsy. Neurorehabil Neural Repair 2013; 27:542-51. [DOI: 10.1177/1545968313481280] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Bell’s palsy (BP) is the most frequent form of peripheral palsy of the facial nerve. Prognosis for recovery is good for most patients; in the remaining cases, different grades of residual impairment persist. Physical therapy, in association with drug administration, aims to improve outcomes. Objective. To assess the efficacy of early physical therapy in association with standard drug administration versus pharmacological therapy only, in terms of time to maximum gains and grade of recovery of function, and to examine who will most benefit from rehabilitation. Methods. From June 2008 to May 2010, 232 individuals were evaluated. The 87 patients meeting the eligibility criteria were randomly assigned to the experimental group (prednisone and valacyclovir plus physical therapy, n = 39) or the control group (pharmacological therapy, n = 48) within 10 days of onset. Intention-to-treat analyses were done. Results. The physical therapy had a significant effect on grade ( P = .038) and time ( P = .044) to recovery only in patients presenting with severe facial palsy (House-Brackmann [HB] grade V/VI). No significant differences were found between the study and control groups for outcome of synkinesis. Conclusion. Physical therapy appears to be effective only in the more severe BP (baseline HB grade V/VI), whereas less severe BP (baseline HB grade IV) results in complete spontaneous recovery, regardless of physical therapy.
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Affiliation(s)
- Maria Nicastri
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Patrizia Mancini
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | - Daniele De Seta
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - Luca Prosperini
- Department of Neurology and Psychiatry, University Sapienza of Rome, Rome, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, University Sapienza of Rome, Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University Sapienza of Rome, Rome, Italy
| | - Roberto Filipo
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Raslan A, Ernst P, Werle M, Thieme H, Szameit K, Finkensieper M, Guntinas-Lichius O, Irintchev A. Reduced cholinergic and glutamatergic synaptic input to regenerated motoneurons after facial nerve repair in rats: potential implications for recovery of motor function. Brain Struct Funct 2013; 219:891-909. [DOI: 10.1007/s00429-013-0542-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/12/2013] [Indexed: 02/02/2023]
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Abstract
Facial nerve lesions are usually benign conditions even though patients may present with emotional distress. Facial palsy usually resolves in 3-6 weeks, but if axonal degeneration takes place, it is likely that the patient will end up with a postparalytic facial syndrome featuring synkinesis, myokymic discharges, and hemifacial mass contractions after abnormal reinnervation. Essential hemifacial spasm is one form of facial hyperactivity that must be distinguished from synkinesis after facial palsy and also from other forms of facial dyskinesias. In this condition, there can be ectopic discharges, ephaptic transmission, and lateral spread of excitation among nerve fibers, giving rise to involuntary muscle twitching and spasms. Electrodiagnostic assessment is of relevance for the diagnosis and prognosis of peripheral facial palsy and hemifacial spasm. In this chapter the most relevant clinical and electrodiagnostic aspects of the two disorders are reviewed, with emphasis on the various stages of facial palsy after axonal degeneration, the pathophysiological mechanisms underlying the various features of hemifacial spasm, and the cues for differential diagnosis between the two entities.
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Akalin MA, Kiziltan ME, Benbir G. Blink reflex in patients with postparalytic facial syndrome and blepharospasm: trigeminal and auditory stimulation. Clin Neurophysiol 2012; 124:120-5. [PMID: 22854209 DOI: 10.1016/j.clinph.2012.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/05/2012] [Accepted: 05/26/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The enhancement of blink reflex (BR) excitability was shown in patients with postparalytic facial syndrome (PFS) and essential blepharospasm (EB). We prospectively investigated patients with PFS and EB whether BR alterations demonstrated by trigeminal stimulation will similarly be observed upon auditory stimulation. METHODS Fifteen patients with PFS, 15 patients with EB, and 30 healthy volunteers were involved. Electrically stimulated trigeminal BR and auditory BR were studied bilaterally. RESULTS The mean R2 amplitude and duration values were highest in EB patients, being significantly higher than PFS patients (p < 0.05) and control group (p < 0.01). The mean R2 duration in PFS patients were also significantly longer in compared to control group (p = 0.025). EB patients showed a higher mean R (auditory) amplitude and duration than PFS patients (p < 0.05) and controls (p < 0.04). The mean R (auditory) duration was longer on symptomatic side of PFS patients in compared to controls (p = 0.05). CONCLUSIONS We observed that there is an enhanced excitability of BR circuit in postparalytic facial syndrome and essential blepharospasm, which could be evoked by auditory stimulation in addition to trigeminal stimulation. SIGNIFICANCE The enhanced excitability in patients with EB and PFS probably originates from the final common pathway of BR circuit, namely facial motor or premotor neurons.
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Affiliation(s)
- M A Akalin
- Istanbul University Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul 34098, Turkey
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Malhotra HS, Garg RK, Goel MM, Jain A, Gupta A, Lalla R, Singh GP. Bilateral facial synkinesis in leprosy. BMJ Case Rep 2012; 2012:bcr.01.2012.5624. [PMID: 22669019 DOI: 10.1136/bcr.01.2012.5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leprosy is an important cause of cranial nerve palsy in endemic areas where it may be seen in upto 17.6% patients. The authors herein describe a rare case of bilaterally symmetrical facial synkinesis with video documentation and modified blink reflex. A 35-year-old gentleman presented with numbness involving right half of his face for 8 months and abnormal stretching sensations over both sides of his nose for one and a half months. Sensory and motor involvement of the right trigeminal nerve was detected along with bilaterally symmetrical facial synkinesis involving orbicularis oculi and nasalis. R(1) and R(2) responses consistent with mis-reinnervation were recorded on the left-side using orbicularis oculi and nasalis muscles. Skin biopsy revealed acid-fast bacilli and sural nerve biopsy, the presence of granulomas. After 3 months of follow-up on WHO multi-drug therapy, an improvement in facial sensations was observed but without any change in facial synkinetic movements.
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Affiliation(s)
- Hardeep Singh Malhotra
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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Terzis JK, Karypidis D. Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients. J Plast Reconstr Aesthet Surg 2012; 65:1009-18. [PMID: 22483723 DOI: 10.1016/j.bjps.2012.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/26/2012] [Accepted: 03/08/2012] [Indexed: 01/08/2023]
Abstract
UNLABELLED Synkinetic movements comprise abnormal involuntary contractions of one or more facial muscle groups which follow the desired contraction of another facial muscle group. They are frequently encountered in patients with long standing facial paralysis and seriously affect their psychological status due to the impairment of their facial appearance, function and emotional expressivity. PATIENTS AND METHODS Eleven pediatric patients (2 male and 9 female) presenting with post-facial paralysis synkinesis were included in the study. Mean age was 10.3±4 years and mean denervation time 72.5 months. RESULTS Patients underwent the following types of treatment: --Cross facial nerve grafting (CFNG) and secondary microcoaptations with botulinum toxin injection which had an improvement of 100% (3 in the 3 grade synkinesis scale) (n=2). --Cross facial nerve grafting (CFNG) and secondary microcoaptations without botulinum toxin injection which had an improvement of 66%(2 in the 3 grade synkinesis scale) (n=5). --CFNG and direct muscle neurotization with (n=2) or without (n=1) botulinum toxin injection where the improvement was 33%. --Contralateral nasalis muscle myectomy was performed in one patient along with CFNG and secondary microcoaptations which resulted in 66% synkinesis improvement. Biofeedback was invariably undertaken by all patients. Postoperative improvement in eye closure and smile was also noted in the respective cases treated for synkinesis ranging from 25 to 50%, with all patients achieving optimum functional return. CONCLUSION CFNG with secondary microcoaptations and botulinum toxin injections was found to be a very efficient surgical modality addressing post-facial palsy synkinesis with high improvement in facial function and symmetry. Facial neuromuscular re-education contributes considerably in the treatment.
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Affiliation(s)
- Julia K Terzis
- International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave, Suite 620, Long Island City, NY 11101, USA.
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Casanova-Molla J, León L, Castillo CD, Valls-Solé J. Reinnervation by the contralateral facial nerve in patients with peripheral facial palsy. Muscle Nerve 2011; 44:923-9. [PMID: 22102463 DOI: 10.1002/mus.22207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Reinnervation activity is triggered after complete unilateral peripheral facial palsy (PFP). METHODS In 27 patients with PFP we recorded electromyographic activity with a concentric needle electrode inserted 1 cm lateral to the oral commissure of the affected side. We applied electrical stimuli to the unaffected (contralateral) facial nerve from the tragus to the mid-lower lip and measured the response latency variability and segmental conduction velocity. RESULTS Responses to electrical stimulation of the unaffected facial nerve were found in all patients. Mean conduction velocity was 49.6 ± 6.2 m/s between tragus and oral commissure, and 6.0 ± 1.9 m/s between oral commissure and mid-lower lip. Latency variability was 0.27 ms to facial nerve stimulation and 0.08 ms to oral commissure stimulation. CONCLUSION Short distance sprouting of axons that innervate muscle fibers, which originate from the unaffected facial nerve, results in propagation of impulses to muscle fibers in the midline.
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de Lima PMG, Munhoz RP, Becker N, Teive HAG. Parakinesia brachialis oscitans: report of three cases. Parkinsonism Relat Disord 2011; 18:204-6. [PMID: 22018911 DOI: 10.1016/j.parkreldis.2011.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/20/2011] [Accepted: 09/20/2011] [Indexed: 10/16/2022]
Abstract
The term 'parakinesia brachialis oscitans' (PBO) was coined recently to describe cases of hemiplegia in which spontaneous yawning causes involuntary raising of the affected upper limb. The authors report three additional cases of PBO adding new phenomenological findings to the syndrome, discussing possible physiopathology of this phenomenon.
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Affiliation(s)
- Plínio M G de Lima
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 1103/102, Centro, Curitiba, Pr., 80060-150, Brazil
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Orhan EK, Yayla V, Cebeci Z, Baslo MB, Ovalı T, Öge AE. Excitability changes at brainstem and cortical levels in blind subjects. Clin Neurophysiol 2011; 122:1827-33. [DOI: 10.1016/j.clinph.2011.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 02/02/2011] [Accepted: 02/14/2011] [Indexed: 11/17/2022]
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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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Tuck KK, Yeow TC, Morris JG, Baker F, Fung VS. The use of Fogs' test to assess associated movements in Parkinsonism, dystonia, and controls. Mov Disord 2010; 26:121-4. [DOI: 10.1002/mds.23431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/08/2010] [Accepted: 08/10/2010] [Indexed: 11/10/2022] Open
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What Happens in the Other Eye? Blink Reflex Alterations in Contralateral Side After Facial Palsy. J Clin Neurophysiol 2009; 26:454-7. [DOI: 10.1097/wnp.0b013e3181c29914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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