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Cho KR, Park SK, Park K. Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm. Life (Basel) 2023; 13:1825. [PMID: 37763229 PMCID: PMC10532564 DOI: 10.3390/life13091825] [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: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Hemifacial spasm (HFS) is a rare disorder characterized by involuntary facial muscle contractions. The primary cause is mechanical compression of the facial nerve by nearby structures. Lateral spread response (LSR) is an abnormal muscle response observed during electromyogram (EMG) testing and is associated with HFS. Intraoperative monitoring of LSR is crucial during surgery to confirm successful decompression. Proper anesthesia and electrode positioning are important for accurate LSR monitoring. Stimulation parameters should be carefully adjusted to avoid artifacts. The disappearance of LSR during surgery is associated with short-term outcomes, but its persistence does not necessarily indicate poor long-term outcomes. LSR monitoring has both positive and negative prognostic value, and its predictive ability varies across studies. Early disappearance of LSR can occur before decompression and may indicate better clinical outcomes. Further research is needed to fully understand the implications of LSR monitoring in HFS surgery.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Sang Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
- Department of Neurosurgery, School of Medicine Sungkyunkwan University, Seoul 16419, Republic of Korea
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Amano Y, Asayama B, Noro S, Abe T, Okuma M, Honjyo K, Seo Y, Nakamura H. Significant Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Abnormal Muscle Response in Patients with Hemifacial Spasm. Neurol Med Chir (Tokyo) 2022; 62:513-520. [PMID: 36184478 DOI: 10.2176/jns-nmc.2022-0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief of persistent HFS is one of the main issues. In patients with hemifacial spasm, stimulation of a branch of the affected facial nerve elicits an abnormal response in the muscles innervated by another branch. Several specific types of waves were found in the abnormal muscle response (AMR). This study aimed to confirm the relationship between the initial morphology of the AMR wave and delayed relief of persistent HFS after MVD. We retrospectively analyzed and compared the data from 47 of 155 consecutive patients who underwent MVD for HFS at our hospital between January 2015 and March 2020. Based on the pattern of the initial AMR morphology on orbicularis oculi and mentalis muscle stimulation, patients were divided into two groups, namely, the monophasic and polyphasic groups. The results of MVD surgery for HFS were evaluated 1 week, 1 month, and 1 year postoperatively, by evaluating whether or not the symptoms of HFS persisted at the time of each follow-up. There were significantly higher rates of persistent postoperative HFS in patients with the polyphasic type of initial AMR at 1 week and 1 month after the surgery (p < 0.05, respectively), as assessed using Yates chi-squared test and Fisher's exact test. A significant correlation was observed between delayed relief after MVD and polyphasic morphology of the AMR in electromyographic analysis in patients with hemifacial spasm.
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Affiliation(s)
- Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital
| | | | - Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital
| | - Takenori Abe
- Department of Neurology, Nakamura Memorial Hospital
| | | | - Kaori Honjyo
- Department of Neurosurgery, Nakamura Memorial Hospital
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital
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Szmyd B, Sołek J, Błaszczyk M, Jankowski J, Liberski PP, Jaskólski DJ, Wysiadecki G, Karuga FF, Gabryelska A, Sochal M, Tubbs RS, Radek M. The Underlying Pathogenesis of Neurovascular Compression Syndromes: A Systematic Review. Front Mol Neurosci 2022; 15:923089. [PMID: 35860499 PMCID: PMC9289473 DOI: 10.3389/fnmol.2022.923089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Neurovascular compression syndromes (NVC) are challenging disorders resulting from the compression of cranial nerves at the root entry/exit zone. Clinically, we can distinguish the following NVC conditions: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Also, rare cases of geniculate neuralgia and superior laryngeal neuralgia are reported. Other syndromes, e.g., disabling positional vertigo, arterial hypertension in the course of NVC at the CN IX-X REZ and torticollis, have insufficient clinical evidence for microvascular decompression. The exact pathomechanism leading to characteristic NVC-related symptoms remains unclear. Proposed etiologies have limited explanatory scope. Therefore, we have examined the underlying pathomechanisms stated in the medical literature. To achieve our goal, we systematically reviewed original English language papers available in Pubmed and Web of Science databases before 2 October 2021. We obtained 1694 papers after eliminating duplicates. Only 357 original papers potentially pertaining to the pathogenesis of NVC were enrolled in full-text assessment for eligibility. Of these, 63 were included in the final analysis. The systematic review suggests that the anatomical and/or hemodynamical changes described are insufficient to account for NVC-related symptoms by themselves. They must coexist with additional changes such as factors associated with the affected nerve (e.g., demyelination, REZ modeling, vasculature pathology), nucleus hyperexcitability, white and/or gray matter changes in the brain, or disturbances in ion channels. Moreover, the effects of inflammatory background, altered proteome, and biochemical parameters on symptomatic NVC cannot be ignored. Further studies are needed to gain better insight into NVC pathophysiology.
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Affiliation(s)
- Bartosz Szmyd
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Julia Sołek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Maciej Błaszczyk
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Jakub Jankowski
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Paweł P. Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| | - Filip F. Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- University of Queensland, Brisbane, QLD, Australia
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
- *Correspondence: Maciej Radek
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Park CK, Lim SH, Lee SH, Park BJ. Is the pre-operative lateral spread response on facial electromyography a valid diagnostic tool for hemifacial spasm? Neurosurg Rev 2021; 44:3259-3266. [PMID: 33559796 DOI: 10.1007/s10143-020-01267-6] [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: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
The lateral spread response (LSR) on preoperative facial electromyogram (EMG) is a useful tool in evaluating patients with hemifacial spasm (HFS). There may be some instances where the LSR does not appear on the preoperative EMG, thus disrupting the diagnosis and treatment of HFS. In this study, we evaluated the patients who did not exhibit LSR on preoperative EMG but underwent microvascular decompression (MVD) for hemifacial spasm. We searched for patients who underwent MVD for HFS but had an absence of LSR on preoperative EMG between January 2016 and June 2018. Surgical outcomes were evaluated at 1, 3, and 6 months after surgery. Follow-up facial EMG was performed 3 months after surgery. Results were divided into two categories: (1) spasm relief within 24 h of surgery and (2) spasm was observed immediately post-operation. The following parameters were analyzed when comparing between the two groups: age, sex, affected side, duration of symptoms, and offending vessel(s). A total of 306 patients underwent MVD for HFS during the study period. Among them, 13 (4.2%) patients had no LSR on preoperative EMG. Eight patients (61.5%) were female and five patients were male. The 13 patients had a mean age of 51 years. All patients exhibited probable offending vessels in the root exit zone (REZ) of the facial nerve on preoperative magnetic resonance (MR) imaging that was confirmed during surgery. Seven patients were free of HFS immediately after surgery, though six patients were not. Only one (7.7%) patient had persisted symptom 6 months after surgery. No patients experienced recurrence of spasm, nor exhibited abnormal waves on follow-up facial EMG. LSR on facial EMG is a valuable tool for evaluating hemifacial spasm. However, although LSR did not appear on preoperative EMG, if the patient presents with typical symptoms and the offending vessels are identified on MRI, we expect good results after MVD for HFS.
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Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea
| | - Seung Hoon Lim
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea
| | - Seung Hwan Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea
| | - Bong Jin Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea.
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Park JS, Lee S, Park SK, Lee JA, Park K. Facial motor evoked potential with paired transcranial magnetic stimulation: prognostic value following microvascular decompression for hemifacial spasm. J Neurosurg 2018; 131:1780-1787. [PMID: 30579277 DOI: 10.3171/2018.8.jns18708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Microvascular decompression (MVD) is widely considered the treatment of choice for hemifacial spasm (HFS), but not all patients immediately benefit from it. Numerous electrophysiological tests have been employed to monitor the integrity of the facial nerve prior to, during, and after MVD treatment. The authors sought to verify if facial motor evoked potential (FMEP) with paired transcranial magnetic stimulation (pTMS) can be utilized as a tool to predict prognosis following MVD for HFS. METHODS FMEP using pTMS was performed preoperatively and postoperatively for 527 HFS patients who underwent an MVD treatment. Various interstimuli intervals (ISIs), which included 2, 10, 20, 25, 30, 75, and 100 msec, were applied for each paired stimulation and pTMS(%) was obtained. A graph of pTMS(%) versus each ISI was drawn for every patient and its pattern was analyzed in accordance with patients' clinical outcomes. RESULTS With ISIs of 75 and 100 msec, pTMS(%) was physiologically further inhibited, whereas it was relatively facilitated under ISIs of 20, 25, and 30 msec; loss of this specific pattern, that is, further inhibition-relative facilitation, indicated impaired integrity of the facial nerve. Those patients who immediately benefited from an MVD and experienced no relapse tended to show proper restoration of this further inhibition-relative facilitation pattern (p = 0.01). Greater resemblance between the physiological pattern of pTMS(%) and postoperative pTMS(%) was correlated to better outcome (p = 0.019). CONCLUSIONS A simple linear graph of pTMS(%) versus each ISI may be a helpful tool to predict prognosis for HFS following an MVD.
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Affiliation(s)
- Jae Sung Park
- Departments of1Neurosurgery and
- 3Department of Neurosurgery, Konkuk University School of Medicine, Chungju, South Korea
| | | | - Sang-Ku Park
- 2Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
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Lefaucheur JP. New insights into the pathophysiology of primary hemifacial spasm. Neurochirurgie 2018; 64:87-93. [DOI: 10.1016/j.neuchi.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
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Kim CH, Kong DS, Lee JA, Park K. The Potential Value of the Disappearance of the Lateral Spread Response During Microvascular Decompression for Predicting the Clinical Outcome of Hemifacial Spasms: A Prospective Study. Neurosurgery 2018; 67:1581-1588. [PMID: 27759660 DOI: 10.1227/neu.0b013e3181f74120] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is a benign, chronic, involuntary movement of the muscles involved in facial expressions that typically begins in the orbicularis oculi and spreads to the other expression muscles over several years. OBJECTIVE To clarify the effectiveness of intraoperative electromyogram during microvascular decompression (MVD) for HFS. METHODS Two hundred ninety-nine consecutive patients with HFS underwent continuous intraoperative monitoring during MVD. The patients were divided into 2 groups based on whether the lateral spread response (LSR) disappeared before or after decompression RESULTS:: In 276 of 299 patients (92.3%), the LSR was observed during intraoperative facial electromyogram monitoring. The mean follow-up period was 17.9 months (range, 12-27 months). Three patients in whom the LSR persisted despite decompression were not included in this study. In 183 of the 273 patients (67%), the LSR disappeared after decompression (group A); in the remaining 90 (33%), the LSR disappeared at dural opening or after drainage of the cerebrospinal fluid before decompression (group B). At the postoperative 3-month and 2-year follow-up visits, there were significant differences in the clinical outcomes between the 2 groups (P < .05). CONCLUSION The disappearance of the LSR before and after MVD may predict clinical outcomes. This must be considered together with the disappearance or persistence of LSR after decompression as a prognostic factor for HFS after MVD.
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Affiliation(s)
- Chang-Hyun Kim
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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da Silva Martins WC, de Albuquerque LAF, de Carvalho GTC, Dourado JC, Dellaretti M, de Sousa AA. Tenth case of bilateral hemifacial spasm treated by microvascular decompression: Review of the pathophysiology. Surg Neurol Int 2017; 8:225. [PMID: 29026661 PMCID: PMC5629840 DOI: 10.4103/sni.sni_95_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bilateral hemifacial spasm (BHFS) is a rare neurological syndrome whose diagnosis depends on excluding other facial dyskinesias. We present a case of BHFS along with a literature review. METHODS A 64-year-old white, hypertense male reported involuntary left hemiface contractions in 2001 (aged 50). In 2007, right hemifacial symptoms appeared, without spasm remission during sleep. Botulinum toxin type A application produced partial temporary improvement. Left microvascular decompression (MVD) was performed in August 2013, followed by right MVD in May 2014, with excellent results. Follow-up in March 2016 showed complete cessation of spasms without medication. RESULTS The literature confirms nine BHFS cases bilaterally treated by MVD, a definitive surgical option with minimal complications. Regarding HFS pathophysiology, ectopic firing and ephaptic transmissions originate in the root exit zone (REZ) of the facial nerve, due to neurovascular compression (NVC), orthodromically stimulate facial muscles and antidromically stimulate the facial nerve nucleus; this hyperexcitation continuously stimulates the facial muscles. These activated muscles can trigger somatosensory afferent skin nerve impulses and neuromuscular spindles from the trigeminal nerve, which, after transiting the Gasser ganglion and trigeminal nucleus, reach the somatosensory medial posterior ventral nucleus of the contralateral thalamus as well as the somatosensory cortical area of the face. Once activated, this area can stimulate the motor and supplementary motor areas (extrapyramidal and basal ganglia system), activating the motoneurons of the facial nerve nucleus and peripherally stimulating the facial muscles. CONCLUSIONS We believe that bilateral MVD is the best approach in cases of BHFS.
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Affiliation(s)
| | | | - Gervásio Teles Cardoso de Carvalho
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jules Carlos Dourado
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Dellaretti
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Neurosurgery, Hospital das Clínicas de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Atos Alves de Sousa
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Schroeder HWS. The value of lateral spread response monitoring in predicting the clinical outcome after microvascular decompression in hemifacial spasm: a prospective study on 100 patients. Neurosurg Rev 2016; 39:455-66. [PMID: 27053220 DOI: 10.1007/s10143-016-0708-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 11/13/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Microvascular decompression represents an effective treatment for hemifacial spasm. The use of lateral spread response (LSR) monitoring remains a useful intraoperative tool to ensure adequate decompression of the facial nerve. The aim of this study was to assess the value of LSRs intraoperative monitoring as a prognostic indicator for the outcome of microvascular decompression in hemifacial spasm. Our study included 100 patients prospectively. The patients were classified into four groups whether LSRs were totally, partially, not relieved, or not detected from the start. According to clinical outcome, the patients were classified into four groups depending on the clinical course after surgery and the residual symptoms if any. Then, correlations were made between LSR events and treatment outcome to detect its reliability as a prognostic indicator. LSRs were relieved totally in 56 % of the patients, partially relieved in 14 %, not relieved in 10 %, and were not detected in 20 % of the patients from the start. HFS was relieved directly after operation in 62 % with clinical improvement of 90-100 %. Thirty-one percent described 50-90 % improvement over the next 3 months after surgery. Almost all of these 31 % (28 out of 31 patients) reported further clinical improvement of 90-100 % within 1 year after surgery. Three percent suffered from a relapse after a HFS-free period, and 4 % reported minimal or no improvement describing 0-50 % of the preoperative state. The percentage of the satisfied patients with the clinical outcome who reported after 1 year a clinical improvement of 90-100 % was 90 %. Statistical analysis did not find a significant correlation between the relief of LSRs and clinical outcome. LSRs may only represent an intraoperative tool to guide for an adequate decompression but failed to represent a reliable prognostic indicator for treatment outcome.
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Affiliation(s)
- Ahmed El Damaty
- Department of Neurosurgery, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt. .,Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
| | | | - Marc Matthes
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Joerg Baldauf
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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Hemifacial spasm and neurovascular compression. ScientificWorldJournal 2014; 2014:349319. [PMID: 25405219 PMCID: PMC4227371 DOI: 10.1155/2014/349319] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 12/15/2022] Open
Abstract
Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.
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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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Kang MC, Choi YS, Choi HK, Lee SH, Ghang CG, Kim CH. Efficacy of the Disappearance of Lateral Spread Response before and after Microvascular Decompression for Predicting the Long-Term Results of Hemifacial Spasm Over Two Years. J Korean Neurosurg Soc 2012; 52:372-6. [PMID: 23133727 PMCID: PMC3488647 DOI: 10.3340/jkns.2012.52.4.372] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/15/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this large prospective study is to assess the association between the disappearance of the lateral spread response (LSR) before and after microvascular decompression (MVD) and clinical long term results over two years following hemifacial spasm (HFS) treatment. Methods Continuous intra-operative monitoring during MVD was performed in 244 consecutive patients with HFS. Patients with persistent LSR after decompression (n=22, 9.0%), without LSR from the start of the surgery (n=4, 1.7%), and with re-operation (n=15, 6.1%) and follow-up loss (n=4, 1.7%) were excluded. For the statistical analysis, patients were categorized into two groups according to the disappearance of their LSR before or after MVD. Results Intra-operatively, the LSR was checked during facial electromyogram monitoring in 199 (81.5%) of the 244 patients. The mean follow-up duration was 40.9±6.9 months (range 25-51 months) in all the patients. Among them, the LSR disappeared after the decompression (Group A) in 128 (64.3%) patients; but in the remaining 71 (35.6%) patients, the LSR disappeared before the decompression (Group B). In the post-operative follow-up visits over more than one year, there were significant differences between the clinical outcomes of the two groups (p<0.05). Conclusion It was observed that the long-term clinical outcomes of the intra-operative LSR disappearance before and after MVD were correlated. Thus, this factor may be considered a prognostic factor of HFS after MVD.
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Affiliation(s)
- Min-Cheol Kang
- Department of Neurosurgery, Cerebro-Vascular Center, Bongseng Memorial Hospital, Busan, Korea
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Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien) 2012; 154:799-805. [PMID: 22354720 DOI: 10.1007/s00701-012-1304-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated. METHODS Thirty-two patients with typical hemifacial spasm and 12 with trigeminal neuralgia as a control were included. The facial muscle response was recorded during microvascular decompression surgery while the offending artery wall was stimulated (2 mA × 0.2 ms). The latency, amplitude, and effective refractory period were analyzed. RESULTS A waveform was recorded from the facial muscles of patients with hemifacial spasm when the offending artery wall was stimulated and was named the "Z-L response." The latency was 7.3 ± 0.8 ms, the amplitude was 0.08 ± 0.02 mV, and the effective refractory period was 3.5-4 ms. The Z-L response disappeared immediately after microvascular decompression. No waveform was recorded from the facial muscles of patients with trigeminal neuralgia while the anterior inferior cerebellar artery, which adheres to the facial nerve, was stimulated (2 mA × 0.2 ms). CONCLUSION We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.
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Fernández-Conejero I, Ulkatan S, Sen C, Deletis V. Intra-operative neurophysiology during microvascular decompression for hemifacial spasm. Clin Neurophysiol 2012; 123:78-83. [DOI: 10.1016/j.clinph.2011.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 10/14/2022]
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Thirumala PD, Shah AC, Nikonow TN, Habeych ME, Balzer JR, Crammond DJ, Burkhart L, Chang YF, Gardner P, Kassam AB, Horowitz MB. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol 2011; 28:56-66. [PMID: 21221005 DOI: 10.1097/wnp.0b013e3182051300] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hemifacial spasm is a socially disabling condition that manifests as intermittent involuntary twitching of the eyelid and progresses to muscle contractions of the entire hemiface. Patients receiving microvascular decompression of the facial nerve demonstrate an abnormal lateral spread response (LSR) in peripheral branches during facial electromyography. The authors retrospectively evaluate the prognostic value of preoperative clinical characteristics and the efficacy of intraoperative monitoring in predicting short- and long-term relief after microvascular decompression for hemifacial spasm. Microvascular decompression was performed in 293 patients with hemifacial spasm, and LSR was recorded during intraoperative facial electromyography monitoring. In 259 (87.7%) of the 293 patients, the LSR was attainable. Patient outcome was evaluated on the basis of whether the LSR disappeared or persisted after decompression. The mean follow-up period was 54.5 months (range, 9-102 months). A total of 88.0% of patients experienced immediate postoperative relief of spasm; 90.8% had relief at discharge, and 92.3% had relief at follow-up. Preoperative facial weakness and platysmal spasm correlated with persistent postoperative spasm, with similar trends at follow-up. In 207 patients, the LSR disappeared intraoperatively after decompression (group I), and in the remaining 52 patients, the LSR persisted intraoperatively despite decompression (group II). There was a significant difference in spasm relief between both groups within 24 hours of surgery (94.7% vs. 67.3%) (P < 0.0001) and at discharge (94.2% vs. 76.9%) (P = 0.001), but not at follow-up (93.3% vs. 94.4%) (P = 1.000). Multivariate logistic regression analysis demonstrated independent predictability of residual LSR for present spasm within 24 hours of surgery and at discharge but not at follow-up. Facial electromyography monitoring of the LSR during microvascular decompression is an effective tool in ensuring a complete decompression with long-lasting effects. Although LSR results predict short-term outcomes, long-term outcomes are not as reliant on LSR activity.
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Affiliation(s)
- Parthasarathy D Thirumala
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Kumar KR, Ng K. Reduced facial nerve hyperexcitability from contralateral cerebral stroke in hemifacial spasm. Mov Disord 2010; 25:1310-2. [PMID: 20310047 DOI: 10.1002/mds.23094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Ishikawa M, Takashima K, Kamochi H, Kusaka G, Shinoda S, Watanabe E. Treatment with botulinum toxin improves the hyperexcitability of the facial motoneuron in patients with hemifacial spasm. Neurol Res 2009; 32:656-60. [PMID: 19660185 DOI: 10.1179/174313209x431129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Botulinum toxin type A (BTX) injection into the orbicularis oculi muscle is an effective treatment for patients with hemifacial spasm (HFS). The objectives of this study were to investigate the effect of this treatment on HFS, in particular the associated hyperexcitability of the facial motor nucleus, and to discuss the potential mechanism of HFS. F waves in the mentalis muscle were examined before, 2 and 6 weeks after the BTX treatment of only the orbicularis oculi muscle in ten patients with HFS. F/M ratio, duration of F waves and frequency of F waves decreased significantly after the BTX treatment compared with those before the BTX treatment. These findings demonstrate that the excitability of the facial motonucleus decreases after BTX treatment of the orbicularis oculi muscle. From these results, we hypothesize that the trigeminal afferent input and the cortical control contribute to the hyperexcitability of the facial motor nucleus in patients with HFS. This warrants further investigation into the pathophysiology of HFS.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Omiya Medical Center, Jichi Medical University, Saitama, Japan.
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Fukunaga A, Ohira T, Kamba M, Ogawa S, Akiyama T, Kawase T. The Possibility of Left Dominant Activation of the Sensorimotor Cortex During Lip Protrusion in Men. Brain Topogr 2009; 22:109-18. [DOI: 10.1007/s10548-009-0101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 05/06/2009] [Indexed: 11/29/2022]
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Sindou M, Keravel Y. Traitement neurochirurgical du spasme hémifacial primaire par décompression vasculaire microchirurgicale. Neurochirurgie 2009; 55:236-47. [DOI: 10.1016/j.neuchi.2009.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
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Hai J, Pan QG. Experimental study on the correlation between abnormal muscle responses and F waves in hemifacial spasm. Neurol Res 2007; 29:553-6. [PMID: 17948344 DOI: 10.1179/016164107x166263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To investigate the correlation between abnormal muscle response (AMR) and F wave by establishing an animal model of hemifacial spasm (HFS). METHODS Both demyelination in the main trunk of the facial nerve just distal to stylomastoid foramen and vascular compression were used to duplicate animal model of HFS in ten New Zealand white rabbits. AMR and F waves were elicited from the orbicularis oculi and mentalis muscles respectively by stimulating marginal mandibular branch of the facial nerve 6 weeks post-operatively. Correlation analyses were used to compare the relationship between AMR/M and F/M amplitude ratio and between the duration of AMRs and F waves. RESULTS There was a linear correlation between the mean values of the AMR/M and F/M amplitude ratio (r=0.8602, p<0.01), which can also be found between the duration of AMRs and F waves (r=0.7702, p<0.01). DISCUSSION Enhanced F waves and AMRs may have the same origin. The F wave can be regarded as a more direct index in the diagnosis pre-operatively, monitoring intraoperatively and follow-up post-operatively in patients with HFS.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, 389 XinCun Rd, Shanghai 200065, China.
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Kong DS, Park K, Shin BG, Lee JA, Eum DO. Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg 2007; 106:384-7. [PMID: 17367059 DOI: 10.3171/jns.2007.106.3.384] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a large retrospective study in which they evaluated the efficacy of intraoperative electromyography (EMG) monitoring of facial musculature during microvascular decompression (MVD) and assessed the predictive value of the lateral spread response (LSR) as a prognostic indicator for the treatment outcome of hemifacial spasm (HFS). METHODS The authors undertook intraoperative monitoring during MVD in 300 consecutive patients with HFS. The patients were divided into two groups based on whether the LSR disappeared or persisted following decompression. The mean follow-up period was 35.8 months (range 12-55 months). In 263 (87.7%) of the 300 patients, the LSR was observed during intraoperative facial EMG monitoring. In 230 (87.4%) of these 263 patients, the LSR disappeared following decompression (Group I), and in the remaining 33 patients (12.5%) the LSR persisted despite decompression (Group II). At the postoperative 1-year follow-up visit, there was a significant difference in clinical outcomes between both groups (p < 0.05). CONCLUSIONS Facial EMG monitoring of the LSR is an effective tool to use when performing complete decompression, and it may be helpful in predicting outcomes.
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Affiliation(s)
- Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Sindou MP, Polo G, Fischer C, Vial C. Chapter 23 Neurovascular conflict and hemifacial spasm. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2006; 58:274-81. [PMID: 16623339 DOI: 10.1016/s1567-424x(09)70076-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M P Sindou
- Department of Neurosurgery, Hôpital Neurologique, University of Lyon, F-69003 Lyon, France.
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Sindou MP. Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien) 2005; 147:1019-26; discussion 1026. [PMID: 16094508 DOI: 10.1007/s00701-005-0583-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 06/01/2005] [Indexed: 10/25/2022]
Abstract
There is considerable evidence that primary Hemi-Facial Spasm (HFS) is in almost all cases related to a vascular compression of the facial nerve at its Root Exit Zone (REZ) from brainstem, and that Micro-Vascular Decompression (MVD) constitutes its curative treatment. Clinical as well as electrophysiological features plead for mechanisms of the disease in structural lesions at the neural fibers (putatively: focal demyelination at origin of ephapses) and functional changes in the nuclear cells (hyperactivity of the facial nucleus). Lateral Spread Responses (LSRs) elicited by stimulation of the facial nerve branches testify of these electrophysiological perturbations. Monitoring LSRs during surgery is feasible; however the practical value of their intraoperative disappearance as control-test of an effective decompression remains controversial.MVD allows cure of the disease in most cases. Because the VIIIth nerve is at risk during surgery, intraoperative monitoring of Brainstem Auditory Evoked Potentials (BEAPs) is of value to reduce occurrence of hearing loss. Increase in latency of Peak V and decrease in amplitude of Peak I are warning-signals of an excessive stretching of the the cochlear nerve and impairment of the cochlear vascular supply, respectively.
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Affiliation(s)
- M P Sindou
- Department of Neurosurgery, Hopital Neurologique, University of Lyon, Lyon, France.
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Oge AE, Yayla V, Demir GA, Eraksoy M. Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia. Clin Neurophysiol 2005; 116:1542-54. [PMID: 15953558 DOI: 10.1016/j.clinph.2005.02.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 02/09/2005] [Accepted: 02/21/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the electrophysiological excitability characteristics of the facial nucleus and related structures in hemifacial spasm (HFS), post-facial palsy synkinesis (PFPS) and facial myokymia (FM). METHODS Facial F-waves, blink reflex recoveries and magnetically elicited silent periods (SP) were prospectively studied in 17 HFS, 17 PFPS, 8 FM cases and in 13 controls. Earlier unpublished observations on abnormal impulse transmission in 36 HFS and 29 PFPS cases were also included. RESULTS Enhanced F-waves were recorded on the symptomatic side in PFPS and HFS cases with a tendency to be more pronounced in PFPS. HFS and PFPS groups both showed an earlier blink reflex recovery, more prominent in PFPS patients, when stimulated and/or recorded on the symptomatic side. Unelicitable SPs were encountered after 24/39 stimulations in 5 patients with PFPS and rarely in HFS cases. Duration of elicitable SPs did not change remarkably. FM group had similar characteristics as normal controls in the 3 electrophysiological tests. Latencies of the lateral and synkinetic spread responses were significantly prolonged in the earlier PFPS group as compared to HFS. In two-point stimulation, both groups showed a greater latency shift in late responses, again more pronounced in PFPS. CONCLUSIONS PFPS and HFS cases had similar enhanced excitability patterns at the facial nucleus and related brain-stem structures, more marked on the symptomatic side and more obvious in the PFPS group. Findings elicited in the FM group were thought to be caused by asynchronous hyperactivity of facial motoneurons. SIGNIFICANCE In this comparative electrophysiological study, similar excitability patterns were found in HFS and PFPS groups, albeit with different intensities.
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Affiliation(s)
- A Emre Oge
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Capa 34390, Istanbul, Turkey.
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Mesrati F, Vecchierini MF. F-waves: neurophysiology and clinical value. Neurophysiol Clin 2004; 34:217-43. [PMID: 15639131 DOI: 10.1016/j.neucli.2004.09.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 09/06/2004] [Indexed: 10/26/2022] Open
Abstract
This review deals with F responses, which are late responses obtained by supramaximal stimulation of virtually all the motor and mixed peripheral nerves. They are recorded over a muscle innervated by the stimulated nerve. The first description of F-waves was published in the fifties. Their neurophysiological mechanisms have been abundantly discussed in the literature leading to a current consensus, whereby F-waves are considered as antidromic responses produced by a pool of motoneurons activated by peripheral nerve stimulation. In the first part of this review, the neurophysiological mechanisms of F-waves as well as the distinction between these and H reflexes are described from a historical point of view. Other late responses are intentionally not reported; nevertheless A-waves are discussed since they are frequently ill-described in a number of conditions. Stimulation and recording procedures as well as F-wave parameters analysis are detailed, with emphasis on measures most useful for clinical purposes. A rigorous F-wave recording method is mandatory for reliable and meaningful analyses. Physiological factors, which influence F-waves such as ageing, drugs and sleep, must be known and their effects discussed. Also, as maturation is an important factor in clinical neurophysiology, data on F-wave ontogenesis are reviewed and discussed. Finally, the different F-wave alterations described so far in the literature, in either peripheral or central disorders, are listed and commented. It is emphasised that F-waves are particularly useful for the diagnosis of polyneuropathies at a very early stage and for the diagnosis of proximal nerve lesions. F-wave recording is indeed one of the rare methods in routine examination allowing at the same time the functional assessment of motor fibres on their proximal segment, and contributing to the evaluation of motoneuronal excitability.
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Affiliation(s)
- F Mesrati
- Service de physiologie, Laboratoire d'explorations fonctionnelles, Groupe hospitalier Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Yamashita S, Kawaguchi T, Fukuda M, Suzuki K, Watanabe M, Tanaka R, Kameyama S. Lateral spread response elicited by double stimulation in patients with hemifacial spasm. Muscle Nerve 2002; 25:845-9. [PMID: 12115973 DOI: 10.1002/mus.10123] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In patients with hemifacial spasm (HFS), a lateral spread response (or abnormal muscle response) is recorded from facial muscles after facial nerve stimulation. The origin of this response is not completely understood. We studied the lateral spread responses elicited by double stimulation in 12 patients with HFS during microvascular decompression. The response was recorded from the mentalis muscle by electrical stimulation of the temporal branch of the facial nerve or from the orbicularis oculi muscles by stimulation of the marginal mandibular branch. The interstimulus intervals (ISIs) of double stimulation ranged from 0.5 to 7.0 ms. R1 was defined as the response elicited by the first stimulus, and R2 as the response elicited by the second stimulus. R1 had a constant latency and amplitude regardless of the ISI, whereas R2 appeared after a fixed refractory period without facilitation or depression in a recovery curve of latency and amplitude. From these findings, we consider that the lateral spread response is due to cross-transmission of facial nerve fibers at the site of vascular compression rather than arising from facial nerve motor neurons.
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Affiliation(s)
- Shinya Yamashita
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan.
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Ishikawa M, Nakanishi T, Takamiya Y, Namiki J. Delayed resolution of residual hemifacial spasm after microvascular decompression operations. Neurosurgery 2001; 49:847-54; discussion 854-6. [PMID: 11564245 DOI: 10.1097/00006123-200110000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2001] [Accepted: 05/21/2001] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE After microvascular decompression to treat hemifacial spasm (HFS), resolution of the HFS is often gradual. We carefully investigated the course of the gradual resolution of HFS and examined the differences between patients with and without postoperative HFS. METHODS One hundred seventy-five patients with HFS were monitored, for observation of 1) whether postoperative HFS occurred, 2) when it occurred, and 3) when it disappeared after microvascular decompression. For two groups of patients, with (Group I) and without (Group II) postoperative HFS, we investigated age, sex, spasm side, preoperative facial nerve block (botulinum toxin treatment), decompression material, preoperative HFS period, offender (compressing vessel), temporary and permanent postoperative complications, and electromyographic findings. RESULTS In Group I (88 patients), postoperative HFS began within 4 days after surgery, a period that we have termed the silent period of postoperative HFS; the median value for the time to resolution was 28 days. The other 87 patients exhibited no postoperative HFS (Group II). There was a significantly higher incidence of postoperative facial weakness in Group II (Group II, 41.3%; Group I, 25.5%; P = 0.02 by logistic regression analysis). In Group I, there was no statistically significant relationship between the investigated parameters and the silent period or the postoperative HFS period, as determined by Cox proportional-hazards regression analysis, except for the number of preoperative facial nerve blocks. Electromyographic investigation of F waves revealed facial paresis during the silent period in a patient. CONCLUSION Approximately 50% of patients with HFS exhibited residual spasm postoperatively. An immediate postoperative silent period of 4 days without spasm was characteristic. One-quarter, one-half, and 90% of the residual spasm resolved by 1 week, 1 month, and 8 months after surgery, respectively.
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Affiliation(s)
- M Ishikawa
- Department of Neurosurgery, Saitama National Hospital, Saitama, Japan.
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Ishikawa M, Nakanishi T, Takamiya Y, Namiki J. Delayed Resolution of Residual Hemifacial Spasm after Microvascular Decompression Operations. Neurosurgery 2001. [DOI: 10.1227/00006123-200110000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sauvain MO, Magistris MR, Tribolet ND. Microvascular decompression of the facial nerve. ACTA ACUST UNITED AC 2001. [DOI: 10.1053/otns.2001.26620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Wedekind C, Klug N. Assessment of facial nerve function in acoustic tumor disease by nasal muscle F waves and transcranial magnetic stimulation. Muscle Nerve 2000; 23:58-62. [PMID: 10590406 DOI: 10.1002/(sici)1097-4598(200001)23:1<58::aid-mus7>3.0.co;2-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Standard transcranial magnetic stimulation and nasal muscle F-wave recordings were used to assess proximal facial nerve function in 27 patients with unilateral acoustic tumors (mean diameter, 29 mm) and clinically intact facial nerve function. Latency measurements for F waves and cortical magnetic stimulation were abnormal. Moreover, F ratios, central motor conduction time, and the ratio of response latency to cortical and cisternal magnetic stimulation were significantly increased. Amplitudes were unchanged. Correlation analysis with tumor diameter as dependent variable yielded maximum r values for F-wave latencies (0.57) and F ratios (0.41), whereas for magnetic stimulation, a significant correlation could be found (0.4) only for cortical stimulation. Nasal muscle F-wave recording can reveal clinically inapparent facial nerve dysfunction. Its efficacy in predicting tumor diameter seems to be superior to that of standard magnetic stimulation.
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Affiliation(s)
- C Wedekind
- Department of Neurosurgery, University of Cologne, D-50924 Cologne, Germany
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Kojima A, Ohira T, Takase M, Kawase T. Long-latency response to transcranial magnetic stimulation in patients with hemifacial spasm. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 109:285-9. [PMID: 9751289 DOI: 10.1016/s0924-980x(98)00019-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We studied the long-latency response of the orbicularis oris muscle elicited with transcranial magnetic stimulation in patients with hemifacial spasm (HFS) and evaluated the excitability of the facial nucleus. METHODS We compared the thresholds on both sides in 8 normal volunteers and 7 patients with hemifacial spasm. The thresholds were determined as the lowest intensity required to produce motor evoked potentials with an amplitude of at least 50 microV in the orbicularis oris muscle. Average values were given as means +/- standard deviation. Wilcoxon's rank sum test was used for comparisons between the sides of normal subjects and of patients with HFS with respect to the threshold stimulus. RESULTS There was no significant difference between the thresholds on the two sides of the normal subjects (mean 1.88+/-5.30%, P > 0.05). In patients with HFS, there was a significant difference between the thresholds on the spasm side and the normal side (mean 20.7+/-13.0%, P < 0.05) In one patient studied after MVD, the difference between both sides disappeared. CONCLUSION The difference between the thresholds in patients with HFS and the normalization in threshold after MVD suggested that the mechanism of HFS was hyperexcitability of the facial nucleus.
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Affiliation(s)
- A Kojima
- Department of Neurosurgery, Neurophysiology, Keio University School of Medicine, Tokyo, Japan.
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Ishikawa M, Ohira T, Namiki J, Kobayashi M, Takase M, Kawase T, Toya S. Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses. J Neurosurg 1997; 86:654-61. [PMID: 9120630 DOI: 10.3171/jns.1997.86.4.0654] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve-evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 +/- 1.7 (mean +/- standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely. F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.
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Affiliation(s)
- M Ishikawa
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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Ishikawa M, Namiki J, Takase M, Ohira T, Nakamura A, Toya S. Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci 1996; 142:99-106. [PMID: 8902727 DOI: 10.1016/0022-510x(96)00137-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The lateral spread (LS) response, which can be elicited in muscles innervated by other branches of the facial nerve, is electromyographycally specific for patients with hemifacial spasm (HFS), occurring about 10 ms after stimulus. The F-wave in facial muscles, which is a late response that antidromicaly propagates to the facial motonucleus and returns orthodromicaly down the same axon, revealed a trend toward enhancement in patients with HFS. The LSs were facilitated by repetitive stimulation during the microvascular decompression (MVD) operation, which has proved to be a successful treatment, and the F-waves were also facilitated by repetitive stimulation on the spasm side more than on the normal side. Greater facilitation of these responses was in direct proportion to higher stimulation rates and greater numbers of stimulations. The repetitive stimulation of the facial nerve may result in activation of the motoneuron pool and in the lowering of the threshold of somatic membranes. These results support the hypothesis that hemifacial spasm is caused by hyperexcitability of the facial motonucleus, which is increased by antidromic repetitive stimulation.
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Affiliation(s)
- M Ishikawa
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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Ishikawa M, Ohira T, Namiki J, Ajimi Y, Takase M, Toya S. Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm. J Neurol Sci 1996; 137:109-16. [PMID: 8782163 DOI: 10.1016/0022-510x(95)00308-o] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In patients with hemifacial spasm (HFS) the spasm is due to cross compression of the facial nerve by a blood vessel and microvascular decompression (MVD) has proved to be a successful treatment. Abnormal muscle response (AMR), which can be elicited by one facial nerve branch stimulation in muscles innervated by other branches of the facial nerve, is specific for patients with HFS, and the AMR consists of a constant response occurring about 10 ms after stimulus and an afterdischarge with long duration (variable response, autoexcitation). The F-wave in facial muscles is a small recurrent discharge that antidromically propagates to the facial motonucleus and returns orthodromically down the same axon. We measured the AMRs and F-waves of facial muscles in HFS patients in order to investigate the relationship of both potentials and the origin of the AMRs. We obtained facial nerve evoked electromyograms from 10 HFS patients. The afterdischarges of the AMRs and the enhanced F-waves were always elicited at the same time by marginal mandibular branch stimulation of the facial nerve. There was a linear correlation between the duration of these two potentials in each case. Between the duration of the afterdischarge of the AMRs elicited in the mentalis muscles by the zygomatic branch stimulation of the facial nerve and that of the F-waves in the mentalis muscles, there was also a linear correlation in 10 cases. These results suggest that the F-wave and the afterdischarge have the same origin and that the AMR is an exaggerated F-wave.
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Affiliation(s)
- M Ishikawa
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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