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Anudeep DDS, Karthik K, Holla VV, Kamble N, Yadav R, Pal PK, Mahale RR. Ventrolateral medullary compression by vascular contact in primary hemifacial spasm: a radiological analysis. Neurol Sci 2024:10.1007/s10072-024-07602-9. [PMID: 38789836 DOI: 10.1007/s10072-024-07602-9] [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: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The neurovascular conflict (NVC) causing hemifacial spasm (HFS) can also cause compression of ventrolateral medulla (VLM) which contains the central sympathetic neurons. VLM compression has been associated with hypertension. Whether the VLM compression in HFS patients is associated with hypertension is not clear. OBJECTIVE To determine the frequency, severity of VLM compression and its association with hypertension in HFS patients. METHODS A cross-sectional, hospital-based, case control study and recruited 120 study subjects (50 cases of primary HFS, 30 hypertensive and 40 normotensive age-, sex- matched controls). The VLM compression was assessed in magnetic resonance imaging Constructive Interference in Steady State (CISS) 3D sequences. RESULTS Hypertension was present in 30 cases (60%). Six patients with HFS (20%) were detected to be hypertensive after the onset of HFS. VLM compression was seen in 24 cases (48%), 7 hypertensive controls (23.3%) and 5 normotensive controls (10%) (p = 0.03). Twenty-four patients with hypertension had VLM compression and remaining 6 patients with hypertension did not have VLM compression (80% vs 20%; p = 0.02). Normotensive patients did not have VLM compression. Vertebral artery was the most common artery causing VLM compression (22 patients; 7 hypertensive and 5 normotensive controls). CONCLUSION VLM compression is more common in HFS patients as compared to hypertensive and normotensive controls. It is more common in hypertensive HFS patients in comparison with normotensive HFS patients. Microvascular decompression is an option in hypertensive HFS patients with VLM compression if the hypertension is medically refractory.
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Affiliation(s)
- D D S Anudeep
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - K Karthik
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Rohan R Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India.
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Ujihara M, Suzuki S, Kobayashi M, Hirata S, Takabatake K, Hatayama T, Fujimaki T. Is Common Trunk Anomaly Frequent in Hemifacial Spasm? Comparison with Normal Subjects Using Magnetic Resonance Imaging. World Neurosurg 2024:S1878-8750(24)00757-5. [PMID: 38734163 DOI: 10.1016/j.wneu.2024.05.004] [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: 02/14/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Hemifacial spasm (HFS) results from vascular compression at the root exit of the facial nerve. Although the underlying etiology has yet to be identified, it has been suggested that congenital vascular anomalies are involved. We have hypothesized common trunk anomaly of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) which may play a role in HFS. However, no previous studies have directly compared the incidence of this anomaly between HFS patients and normal subjects. The present study was designed to address this gap in the literature. METHODS This case-control study compared magnetic resonance angiography data from 65 HFS patients and 65 normal subjects. Dominant AICA/PICA is defined as the absence of PICA/AICA, with the remaining AICA/PICA supplying both vascular territories. The term "common trunk" encompasses both dominant AICA and dominant PICA. The frequency of common trunk and dominant AICA/PICA was compared between the 2 groups. RESULTS There were no significant differences in the incidence of a common trunk (68.5% and 64.6%), dominant AICA (30.8% and 32.3%) and dominant PICA (37.7% and 32.3%) between the 2 groups. Additionally, no differences were found in the frequency of atherosclerosis risk factors. CONCLUSIONS There was no apparent association between common trunk anomaly and HFS. It is suspected that some vascular anomalies other than a common trunk are involved in HFS.
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Affiliation(s)
- Masaki Ujihara
- Department of Neurosurgery, Saitama Medical University, Saitama, Japan.
| | - Shun Suzuki
- Department of Neurosurgery, Saitama Medical University, Saitama, Japan
| | | | - Sachiko Hirata
- Department of Neurosurgery, Saitama Medical University, Saitama, Japan
| | | | - Toru Hatayama
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Japan
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Eyigürbüz T, Yıldırım Z, Korkut E, Akalın Akkaş E, Adatepe MT, Kale N. Neuroimaging Findings in Hemifacial Spasm: A Single-Center Experience. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.44520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wang C, Zhu X, Xia L, Xie P, Tian X, Shang J, Han Q. Botulinum toxin A improves psychological distress in patients with hemifacial spasm. Acta Neurol Belg 2022; 122:43-49. [PMID: 33515182 DOI: 10.1007/s13760-021-01601-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed at assessing mental health in patients with hemifacial spasm (HFS) and determined the effect of botulinum toxin type A (BTX-A) on psychological distress in patients with HFS. METHODS Ninety-five HFS patients and 95 age- and sex-matched healthy controls were enrolled. Symptom checklist-90 (SCL-90) scores were used to measure psychological distress in HFS patients and healthy controls. The mental health status of HFS patients was also evaluated by SCL-90, before and after the injection of BTX-A. Moreover, for those patients with abnormal mental health, efficacy outcomes after treatment with BTX-A were compared with a propensity score-matched historical cohort without BTX-A treatment. RESULTS The mean scores for interpersonal sensitivity, phobia, anxiety, depression, and somatization were significantly higher among HFS patients than healthy people (P < 0.05). There was no significant difference between female patients and male patients in HFS group (P > 0.05). There were significant improvements in somatization, interpersonal sensitivity, depression, anxiety, and phobia scores before and after treatment (P < 0.05). At 2 months, more patients experienced an improvement in psychological distress in the BTX-A group (61.29% versus 38.71%; P = 0.03). CONCLUSION Patients with HFS are often accompanied by somatization, interpersonal sensitivity, depression, anxiety, and phobia. Our findings suggest that BTX-A can improve these symptoms. However, further well-designed prospective studies are warranted to validate our findings.
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Affiliation(s)
- Chengyun Wang
- Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223000, Jiangsu, China
| | - Xiangyu Zhu
- ICU, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223000, Jiangsu, China
| | - Lei Xia
- Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223000, Jiangsu, China
| | - Peng Xie
- Department of Neurosurgery, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223000, Jiangsu, China
| | - Xiangyang Tian
- Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223000, Jiangsu, China
| | - Jin Shang
- Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223000, Jiangsu, China.
| | - Qiu Han
- Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223000, Jiangsu, China.
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Sindou M, Mercier P. Hemifacial spasm associated with other cranial nerve syndromes: Literature review. Neurochirurgie 2018; 64:101-105. [DOI: 10.1016/j.neuchi.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/13/2018] [Indexed: 11/30/2022]
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Cao J, Jiao J, Du Z, Xu W, Sun B, Li F, Liu Y. Combined Hyperactive Dysfunction Syndrome of the Cranial Nerves: A Retrospective Systematic Study of Clinical Characteristics in 44 Patients. World Neurosurg 2017; 104:390-397. [PMID: 28512048 DOI: 10.1016/j.wneu.2017.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Combined hyperactive dysfunction syndrome (HDS) is defined as the combination symptoms arising from overactivity in cranial nerves, specifically, trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), without an obvious explanatory structural lesion. This study retrospectively analyzes the clinical characteristics of combined HDS treated with microvascular decompression (MVD) in a single institution. METHODS A total of 1450 patients with HDS were treated with MVD in our department during a 10-year period, among which 44 cases of combined HDS were identified. Clinical records and follow-ups were reviewed. RESULTS Combined HDS comprised 3.03% (44/1450) of all HDS in our series, with female predominance compared with single HDS (P = 0.002), including combined TN-HFS (14 cases), combined TN-GPN (26 cases), bilateral TN (2 cases), and combined TN-HFS-GPN (2 cases). The average age at diagnosis of patients with combined HDS (60.9 years) was significantly older than that of patients with single HDS (53.5 years) (P = 0.035). Hypertension was closely associated with the prevalence of combined HDS compared with single HDS (P = 0.009). The curative rate was 97.7% (43/44) after MVD, and the recurrence rate was 3.33%. The incidence rates of postoperative cardiac, pulmonary, thromboembolic, and delirium complications were higher in combined HDS than in single HDS (P < 0.05). CONCLUSIONS Combined HDS is a rarely occurring syndrome usually observed in older females, and the most common types are combined TN-GPN and combined TN-HFS. Age and gender seemed to be causes for developing combined HDS, and MVD shows potential as a favorable treatment choice.
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Affiliation(s)
- Jingwei Cao
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China; Department of Neurosurgery, Qilu Children's Hospital of Shandong University, Shandong, People's Republic of China
| | - Jie Jiao
- Department of Medicine, Shandong University, Shandong, People's Republic of China
| | - Zhenhui Du
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Wenzhe Xu
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Bin Sun
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Feng Li
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China.
| | - Yuguang Liu
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China.
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The association between vertebrobasilar dolichoectasia and hemifacial spasm. Parkinsonism Relat Disord 2016; 32:54-59. [DOI: 10.1016/j.parkreldis.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
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Edmond EC, Sim SXL, Li HH, Tan EK, Chan LL. Vascular tortuosity in relationship with hypertension and posterior fossa volume in hemifacial spasm. BMC Neurol 2016; 16:120. [PMID: 27473840 PMCID: PMC4966585 DOI: 10.1186/s12883-016-0634-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Hemifacial spasm (HFS) is a disabling neurological condition. Vascular tortuosity in HFS patients has not been quantified objectively and its relationship with hypertension and posterior fossa volume (PF) is unknown. In a case control magnetic resonance imaging and angiographic (MRI/A) study, we quantified and compared the vascular tortuosity in HFS and controls, and evaluated its relationship with hypertension and PF. Methods Using a commercially available vessel probe tool, an index of tortuosity based on vessel over chord length was employed to quantify vascular tortuosity of the vertebral (VA) and basilar arteries (BA) in 79 subjects (40 HFS, 39 controls). Results The tortuosity index of the BA (1.09 vs 1.16, p = 0.26, 95 % CI 1.07, 1.23), RVA (1.15 vs 1.15, p = 0.83, 95 % CI 1.06, 1.38) and LVA (1.14 vs 1.288, p = 0.16, 95 % CI 1.14, 1.44) was not different between HFS and controls, with adjustments for PF volume and hypertension. Conclusions Contrary to popular belief, our study showed that taking into account hypertension and PF volume, vascular tortuosity of the vertebrobasilar arteries is unlikely to be a major etiologic factor in HFS, though its role in select individuals cannot be excluded. The complex interplay of facial nerve hyperexcitability, genetic predisposition, vascular tortuosity, posterior fossa volume and hypertension needs to be further evaluated.
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Affiliation(s)
- Evan Cyril Edmond
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore.,Oxford Medical School, Oxford, UK
| | - Samantha Xue-Li Sim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore.,Duke NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Hui-Hua Li
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, Singapore, 169608, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Duke NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Ling-Ling Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, 169608, Singapore. .,Duke NUS Graduate Medical School, Singapore, 169857, Singapore.
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Chung M, Han I, Chung SS, Huh R. Side predilections of offending arteries in hemifacial spasm. J Clin Neurosci 2016; 29:106-10. [DOI: 10.1016/j.jocn.2015.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/11/2015] [Indexed: 11/16/2022]
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10
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Revisiting the link between hypertension and hemifacial spasm. Sci Rep 2016; 6:21082. [PMID: 26891766 PMCID: PMC4759578 DOI: 10.1038/srep21082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 01/08/2016] [Indexed: 11/08/2022] Open
Abstract
The relationship between hypertension and hemifacial spasm (HFS) has been debated. Microvascular decompression surgery is effective in some HFS patients with uncontrolled hypertension. To address current gaps in knowledge, we conducted a meta-analysis of case-control studies that have examined the prevalence of hypertension in HFS patients compared to non-HFS controls. We also evaluated the implications and limitations of the pooled studies. We identified 62 studies from PubMed, The Cochrane Library, Web of Science and Scholar.google.com and six studies that fit our inclusion criteria were included. A random-effects model was used to derive the pooled estimate of the Odds Ratio. The data was plotted on a Forest plot. A pooled analysis involving 51585 subjects, 549 cases, 720 neurological controls and 50316 controls from the general population, showed that HFS patients had a higher chance of developing hypertension (OR = 1.72, 95% CI = (1.12, 2.31), p-value <0.001). The prevalence of hypertension was higher in HFS patients as compared to non-HFS patients. This meta-analysis highlights a positive correlation between hypertension and HFS. Blood pressure should be closely monitored during the follow-up of HFS patients. Preliminary links between ventrolateral medullary (VLM) compression and HFS should be further evaluated in future studies.
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Does arteriosclerosis contribute to hemifacial spasm? Acta Neurochir (Wien) 2016; 158:181-7; discussion 188. [PMID: 26545931 DOI: 10.1007/s00701-015-2628-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is caused by pulsative vascular compression of the root exit zone (REZ) of the facial nerve. However, the mechanism that causes the offending vessels to compress the REZ has not been clarified. Elongation of intracranial arteries due to arteriosclerosis is one possibility, but such arteriosclerotic changes are not observed very frequently among patients with HFS. The aim of the present study was to investigate whether arteriosclerotic changes would contribute to the pathogenesis of HFS. METHODS This study included 111 HFS patients, all of whom were Japanese. The prevalence rates of hypertension, hyperlipidemia, and diabetes mellitus were examined as risk factors of atherosclerosis, and the cardio-ankle vascular index (CAVI) was measured as an indicator of arteriosclerotic change. The severity of white matter lesions (WMLs) in HFS patients was measured by magnetic resonance imaging. These data were compared with data from healthy Japanese controls. RESULTS The prevalence rates of the risk factors for atherosclerosis in the HFS patients were not higher than those in the general Japanese population. The CAVI scores for the HFS patients were similar to, or lower than those in the healthy controls for all age groups except 60 to 69-year-old men. The severity of WMLs in the HFS patients was not significantly worse than that in the controls. CONCLUSIONS It is suggested that arteriosclerotic changes are not involved in the pathogenesis of HFS, and that vascular compression syndromes are attributable to anatomical features of the intracranial arteries and facial nerves formed during the prenatal stage.
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Sindou M, Mahmoudi M, Brînzeu A. Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension. J Neurosurg 2015; 123:1405-13. [DOI: 10.3171/2014.12.jns141775] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC).
METHODS
Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated.
RESULTS
Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant.
CONCLUSIONS
These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.
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Affiliation(s)
- Marc Sindou
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
| | - Mohamed Mahmoudi
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
- 2Section of Neurosurgery, Regional Military Hospital of Oran (HMRUO), Oran, Algeria; and
| | - Andrei Brînzeu
- 1Department of Neurosurgery, University of Lyon 1, Hôpital Neurologique “Pierre Wertheimer,” Lyon, France
- 3University of Medicine “Victor Babes,” Timisoara, Romania
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Rudzińska M, Wójcik-Pędziwiatr M, Malec-Litwinowicz M, Grabska N, Hartel M, Flak M, Szczudlik A. Is hypertension a risk factor of hemifacial spasm? Neurol Neurochir Pol 2015; 50:69-74. [PMID: 26969561 DOI: 10.1016/j.pjnns.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/20/2015] [Accepted: 11/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The published data on the relation between arterial hypertension (AH) and hemifacial spasm (HFS) are controversial. The aim of the study was to determine the prevalence of AH in HFS patients and the relation of AH and compression of the brainstem at the region of vasomotor center. MATERIALS AND METHODS The study included 60 of primary HFS patients and 60 healthy controls matched by age. AH was defined according to WHO criteria. The vessel compression of the brainstem was measure on MRI scans in selected region of vasomotor center located in the ventro-lateral medulla (VLM), between the pontomedullary junction, retro-olivary sulcus and the root entry zone (REZ) of the IX and X nerves. Modeling and compression severity of the VLM was graded in the 0-3 scale. RESULTS The prevalence of AH in HFS patients did not differ significantly from the control group (61.6% vs 45.0%, p=ns). VML compression by vessel was frequently found in HFS patients with AH than without AH (97.2% vs 60.9%, χ(2)=11.0, p=0.0009). A similar relation was also found in the control group. The higher rate of VML vascular compression was related to the presence of AH in both, HFS patients and control group. CONCLUSION The prevalence of AH in HFS patients does not differ from controls. The VLM compression in HFS patients and controls is related to AH diagnosis. The association between AH and VLM compression is stronger in patients with higher degree of VLM compression.
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Affiliation(s)
- Monika Rudzińska
- Department of Neurology, Medical University of Silesia, Faculty of Medicine, Katowice, Poland.
| | - Magdalena Wójcik-Pędziwiatr
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | - Michalina Malec-Litwinowicz
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | - Natalia Grabska
- Department of Neurology with Unit of Stroke and Unit of Neurological Rehabilitation, The John Paul II Hospital, Krakow, Poland
| | | | - Maria Flak
- Department of Neurology, Medical University of Silesia, Faculty of Medicine, Katowice, Poland
| | - Andrzej Szczudlik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Cheng J, Fang Y, Zhang H, Lei D, Wu W, You C, Mao B, Mao K. Quantitative Study of Posterior Fossa Crowdedness in Hemifacial Spasm. World Neurosurg 2015; 84:920-6. [DOI: 10.1016/j.wneu.2015.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Sindou M. Is there a place for microsurgical vascular decompression of the brainstem for apparent essential blood hypertension? a review. Adv Tech Stand Neurosurg 2015; 42:69-76. [PMID: 25411145 DOI: 10.1007/978-3-319-09066-5_4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are anatomical and physiological evidences that the ventrolateral (VL) region of the medulla plays an important role in blood pressure regulation and that dysfunction at this level may generate hypertension (HT). Vascular compression by a megadolicho-artery from the vertebrobasilar arterial system at the root entry/exit zone (REZ) of the glossopharyngeal (IXth) and vagal (Xth) cranial nerves (CNs) and the adjacent VL aspect of the medulla has been postulated as a causal factor for HT from neurogenic origin. The first attempts at microvascular decompression (MVD) of the IX-Xth CNs together with the neighbouring VL brainstem was revealed promising. These surgical attempts, as well as the numerous MRI studies, with the goal to detect and identify likely responsible neurovascular conflicts (NVC), are reviewed. Established criteria for indication of MVD as an aetiological treatment of apparent essential HT are still needed.
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Affiliation(s)
- Marc Sindou
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, University Lyon 1, G.H.E, 59 Boulevard Pinel, Lyon, 69003, France,
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Rudzińska M, Wójcik-Pędziwiatr M, Malec M, Grabska N, Hartel M, Szczudlik A. Small volume of the posterior cranial fossa and arterial hypertension are risk factors of hemifacial spasm. Neurol Neurochir Pol 2014; 48:383-6. [DOI: 10.1016/j.pjnns.2014.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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Sandell T, Holmen J, Eide PK. Hypertension in patients with cranial nerve vascular compression syndromes and comparison with a population-based cohort. J Neurosurg 2013; 119:1302-8. [PMID: 23991839 DOI: 10.3171/2013.7.jns13231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although essential arterial hypertension (AH) represents a major health issue, its underlying causes remain unknown. An intriguing hypothesis is that AH in some cases may be caused by vascular compression of the rostral ventrolateral medulla (RVLM). Because hemifacial spasms (HFSs) are caused by vascular compression of the seventh cranial nerve in close proximity to the RVLM, one would, if this hypothesis is correct, expect to find a positive association between the occurrence of AH and chronic HFSs. Such a positive association would not be expected in patients with trigeminal neuralgia (TN), since TN is caused by vascular compression of the fifth cranial nerve, which is not close to the RVLM. METHODS In view of this background, the authors conducted a retrospective population-based study to investigate how the occurrence of AH in patients with either HFSs or TN compares with the prevalence of AH in the general population, when adjusted for sex and age. The general population was represented by participants of the Nord-Trøndelag Health Study 3 (HUNT3). RESULTS The prevalence of AH in the authors' patients with HFSs was significantly higher than in a sex- and age-adjusted sample from the general population; this was not true for the patients with TN. CONCLUSIONS The authors suggest that the data provide supporting evidence to the theory that compression of the RVLM may be one cause of AH.
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Affiliation(s)
- Tiril Sandell
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet
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18
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Katan M, Elkind MSV. Inflammatory and neuroendocrine biomarkers of prognosis after ischemic stroke. Expert Rev Neurother 2011; 11:225-39. [PMID: 21306210 DOI: 10.1586/ern.10.200] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Stroke is the third leading cause of mortality in the USA and one of the leading causes of severe morbidity. It is important to provide stroke patients and physicians with the most accurate prognostic information to optimize care and allocation of healthcare resources. Reliable prognostic markers available during the initial phase after acute stroke may aid clinical decision-making. Several interesting candidate biomarkers have been studied to address prognostic questions; this article will focus on selected inflammatory and neuroendocrine markers. The utility of a biomarker is defined by its ability to improve clinical decision-making and add timely information beyond that readily available from clinical examination and routine imaging. This aim has not been completely achieved yet for any biomarkers, but promising data are available and further studies are ongoing.
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Affiliation(s)
- Mira Katan
- Stroke Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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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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20
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Abstract
Hemifacial spasm (HFS) is a peripherally induced movement disorder causing clonic or tonic contractions of the facial muscles. HFS is usually unilateral and sporadic. It may be primary (mainly attributed to vascular compressions of the seventh cranial nerve in the posterior fossa) or secondary to facial nerve or brainstem damage. The two forms share a number of features but may differ in clinical presentation (simultaneous involvement of the upper and lower facial muscles in secondary forms). The spasm-related electromyogram activity is probably generated by ephaptic transmission, due to local demyelination at the entry zone of the facial nerve root (possibly owing to nerve damage caused by a compressing cerebral vessel). These findings suggest the "nerve origin hypothesis" as the main pathophysiological mechanism underlying HFS. Medical treatment (anticonvulsants or GABAergic drugs) is generally ineffective. Microvascular decompression of the facial nerve can achieve marked improvements in the majority of patients, although recurrences and complications are not uncommon. Local (orbicularis oculi or lower facial muscles) injection of Botulinum toxin (BoNT) is therefore considered the preferred symptomatic treatment for primary HFS. The long-term efficacy and safety of BoNT have been documented by clinical studies.
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21
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El Husseini N, Laskowitz DT. Clinical application of blood biomarkers in cerebrovascular disease. Expert Rev Neurother 2010; 10:189-203. [PMID: 20136376 DOI: 10.1586/ern.09.151] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Identifying a biomarker or panel of biomarkers of cerebral ischemia would have a major impact on the care of stroke patients by facilitating early management decisions and individualization of care. Biochemical surrogates of cerebral ischemia might also play an important role by identifying relevant pathways for novel therapeutic strategies and by facilitating early clinical trials in cerebrovascular disease. Serum biomarkers related to pathways of hemostasis, oxidation and inflammation, or alterations in glial and neuronal proteins, have been identified but none have been recommended for routine clinical use. This review describes the most promising biomarkers of cerebrovascular disease and the context and limitations in which they have been studied.
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Affiliation(s)
- Nada El Husseini
- Department of Medicine-Neurology, Box 2900, Duke University School of Medicine, Durham, NC 27710, USA.
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22
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Huang BR, Chang CN, Hsu JC. Intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm. J Clin Neurosci 2009; 16:209-13. [DOI: 10.1016/j.jocn.2008.04.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Revised: 04/19/2008] [Accepted: 04/21/2008] [Indexed: 11/29/2022]
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Chan LL, Lee E, Fook-Chong S, Tan EK. Case control MR-CISS and 3D TOF MRA imaging study of medullary compression and hypertension in hemifacial spasm. Mov Disord 2008; 23:1820-4. [DOI: 10.1002/mds.22034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Felicio AC, Godeiro-Junior CDO, Borges V, Silva SMDA, Ferraz HB. Clinical assessment of patients with primary and postparalytic hemifacial spasm: a retrospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:783-6. [DOI: 10.1590/s0004-282x2007000500009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/08/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To compared the clinical features of 373 patients with primary and postparalytic hemifacial spasm (HFS). METHOD: Data analyzed were gender, ethnicity, age at symptom onset, disease duration, affected side, distribution of facial spasm at onset, hypertension, family history of HFS, previous history of facial palsy and latency between facial palsy and HFS. RESULTS:The prevalence of patients with Asian origin was similar in both groups such as female/male ratio, mean age at symptom onset, disease duration, affected side and distribution at onset of facial twitching. The upper left side of the face was the main affected region at onset. Almost 40% of the patients in both groups had hypertension. A prevalence of vascular abnormalities on the posterior fossa was seen in 7% and 12.5% of both groups. CONCLUSION: The clinical profile and radiological findings of patients with primary and postparalytic HFS are similar. The association of hypertension with vascular abnormalities and HFS was not frequent.
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Tan EK, Chan LL. Neurovascular compression syndromes and hypertension: clinical relevance. ACTA ACUST UNITED AC 2007; 3:416-7. [PMID: 17609652 DOI: 10.1038/ncpneuro0558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 05/17/2007] [Indexed: 11/09/2022]
Affiliation(s)
- Eng-King Tan
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore.
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Nakamura T, Osawa M, Uchiyama S, Iwata M. Arterial Hypertension in Patients with Left Primary Hemifacial Spasm Is Associated with Neurovascular Compression of the Left Rostral Ventrolateral Medulla. Eur Neurol 2007; 57:150-5. [PMID: 17213721 DOI: 10.1159/000098466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 10/07/2006] [Indexed: 11/19/2022]
Abstract
The aim of the study was to clarify the relationship between neurovascular compression of the rostral ventrolateral medulla and arterial hypertension in patients with primary hemifacial spasm. We enrolled 82 patients with primary hemifacial spasm and 82 age- and sex-matched magnetic resonance imaging (MRI) controls of the posterior cranial fossa. Neurovascular compression of the rostral ventrolateral medulla was assessed by MRI, and its association with arterial hypertension was investigated. No significant differences were found in prevalence of arterial hypertension between patients with primary hemifacial spasm and control subjects (39.0 vs. 29.3%, p=0.19). Thirty-two percent of the patients with left primary hemifacial spasm (n=44) and 47% of the patients with right primary hemifacial spasm (n=38) were hypertensive. Neurovascular compression of the left rostral ventrolateral medulla was observed in 86% of those with left (ipsilateral) primary hemifacial spasm with arterial hypertension (n=14) and 33% of those with left (ipsilateral) primary hemifacial spasm without (n=30). The association between neurovascular compression of the left rostral ventrolateral medulla and arterial hypertension was significant in patients with left (ipsilateral) primary hemifacial spasm (p=0.0012), but not in patients with right (contralateral) primary hemifacial spasm (p=0.18). Neurovascular compression of the left rostral ventrolateral medulla was more frequently observed in hypertensive patients with left primary hemifacial spasm, and neurovascular compression of the left rostral ventrolateral medulla correlated with arterial hypertension in these patients. These results are of potential clinical importance for the treatment of primary hemifacial spasm with arterial hypertension.
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Affiliation(s)
- Tomomi Nakamura
- Department of Neurology, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
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Abstract
INTRODUCTION Hemifacial spasm (HFS) frequently affects middle aged individuals and the clinical features and etiology have been well reported. However, there is limited data on the exact pathogenesis in young-onset HFS. If age is a major determinant of the etiology or influences the presentation of HFS, there may be clinical differences between the young and elderly HFS patients. OBJECTIVES We determined the prevalence, clinical and imaging features of young-onset HFS (age of onset<or=30 years) in a tertiary referral center. These data were compared with old onset (age of onset>or=65 years) HFS patients. METHODS We examined consecutive patients clinically diagnosed with HFS in a tertiary referral center. The clinical (demographics, clinical presentation, severity of HFS, associated medical conditions and other variables) and imaging findings of young onset patients and old onset patients were tabulated and compared. RESULTS Amongst 230 consecutive HFS patients, 15 (6.5%) were young-onset HFS and 50 (21.7%) were old-onset HFS. In the young-onset HFS, the mean age of onset of symptoms was 26.5+/-6.5 (6-30) years, with 80% women and 75.0% of young onset HFS having neurovascular compression (NVC) of the root exit zone (REZ) of the facial nerve on the ipsilateral side; 86.7% had initial onset of twitching in the upper eyelids that later progressed to the lower facial muscles. While the prevalence of hypertension, diabetes mellitus and other associated vascular disorders in late onset HFS was higher than in young onset groups, the clinical features and frequency of NVC of the facial REZ between the two groups were similar. CONCLUSIONS We demonstrated a 6.5% frequency of young-onset HFS in our cohort of HFS and their clinical presentation was similar to the old onset patients. Genetic, anatomic or other unidentified factors may contribute to NVC in young-onset HFS.
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Affiliation(s)
- E K Tan
- Department of Neurology, Singapore General Hospital, Singapore.
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28
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Tan EK, Fook-Chong S, Lum SY, Thumboo J. Validation of a short disease specific quality of life scale for hemifacial spasm: correlation with SF-36. J Neurol Neurosurg Psychiatry 2005; 76:1707-10. [PMID: 16291898 PMCID: PMC1739450 DOI: 10.1136/jnnp.2005.065656] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A short, practical, and validated quality of life (QoL) scale for hemifacial spasm (HFS) is not currently available. OBJECTIVES To examine the reliability and validity of a short self-rating scale (HFS-7) by comparing HFS patients with healthy controls. We also evaluated the correlation of HFS-7 with the physical and mental domains of SF-36, a generic QoL scale. METHODS Seven self-rating items (HFS-7) were administered to HFS patients and healthy controls. In addition, HFS patients answered the SF-36 questionnaire. The validity and reliability of HFS-7 were analysed and correlation between HFS-7 and SF-36 examined. RESULTS A total of 178 subjects were enrolled in the study, including 85 HFS patients with mean age of 54.8 (SD 11.0) years, of whom 52 (61.2%) were women, and 93 controls with mean age of 51.4 (SD 10.0) years, of whom 59 (63.4%) were women. The test-retest intraclass correlation coefficient for the seven items was between 0.75 and 0.90 and Cronbach's coefficient of reliability for the HFS-7 scale was 0.88. Every item in HFS-7 discriminated between disease and controls (p<0.0001). The HFS-7 summary index correlated with the SF-36 summary score (Spearman's correlation r = -0.28, p = 0.009), in particular the mental health summary score (r = -0.416, p<0.0001) and the emotional domain (r = -0.466, p<0.00001). CONCLUSION HFS-7 could prove useful as a simple clinical tool to assess and monitor QoL measures in HFS patients.
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Affiliation(s)
- E K Tan
- Department of Neurology, Singapore General Hospital, Outram Road, Singapore 169608.
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Tan EK, Chan LL. Clinico-radiologic correlation in unilateral and bilateral hemifacial spasm. J Neurol Sci 2004; 222:59-64. [PMID: 15240197 DOI: 10.1016/j.jns.2004.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 03/19/2004] [Accepted: 04/08/2004] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Bilateral hemifacial spasm (HFS) is rare. Clinico-radiologic correlates utilizing advanced imaging techniques have not been systematically examined in bilateral HFS. The prevalence of bilateral HFS in an Asian population has not been clarified. OBJECTIVES We examined the prevalence and clinico-radiologic correlates of bilateral HFS in a clinic-based cohort and compared the clinical characteristics of unilateral HFS patients with and without contralateral neurovascular contact (NVC) in HFS. METHODS Patients clinically diagnosed with HFS were examined for bilateral symptoms. Imaging analysis involved the utilization of reformatted, multi-planar three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA), and constructive interference at steady state (CISS-MR) sequences. The clinical and imaging data was compared between HFS with and without NVC. RESULTS Amongst 162 consecutive HFS patients, 2 (1.6%) had bilateral symptoms. Both patients had unilateral onset followed by bilateral and asynchronous facial contractions. The contralateral side of the face began to twitch at a mean of 1.5 years later. MRI/A revealed significant NVC of the root exit zone (REZ) of the facial nerve on the ipsilateral side with mild NVC contralaterally. The degree of NVC correlated with the clinical severity of the patients' symptoms. MRI/A analysis of 40 HFS patients with unilateral symptoms demonstrated NVC on the contralateral side in six patients (15%). The mean age and duration of symptoms were not different between HFS patients with and without contralateral NVC. CONCLUSIONS We demonstrated clinico-radiologic correlation between the clinical severity and the degree of NVC at the REZ of the facial nerve in bilateral HFS. Amongst unilateral HFS, there was no significant difference clinically between those with and without contralateral NVC. The low 1.6% prevalence of bilateral HFS in our Asian cohort was compatible with the rare prevalence in other ethnic populations.
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Affiliation(s)
- E-K Tan
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore 169608, Singapore.
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30
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Tan EK, Fook-Chong S, Lum SY, Lim E. Botulinum toxin improves quality of life in hemifacial spasm: validation of a questionnaire (HFS-30). J Neurol Sci 2004; 219:151-5. [PMID: 15050451 DOI: 10.1016/j.jns.2004.01.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Revised: 12/08/2003] [Accepted: 01/16/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) can be disabling and affect quality of life. There is a lack of a validated scale for evaluating botulinum toxin (BTX) response in HFS. OBJECTIVE We examined the validity and reliability of a self-rating health-related quality of life (HRQOL) questionnaire (HFS-30) in HFS and investigated the correlation of this questionnaire with the neurologists' assessment of severity of HFS and response to botulinum toxin (BTX) treatment. METHODS HFS patients were asked to answer a total of 30 self-rating questions divided into seven subscales: Mobility; Activities of Daily Living (ADL); Emotional Well-being; Stigma; Social support; Cognition; and Communication. All of the items were scored on a 5-point scales ranging from 0 ("never") to 4 ("always"). They were also asked to assess their response to the BTX treatment based on a similar questionnaire at 6-8 weeks after BTX. The validity, reliability and sensitivity of the questionnaire were analyzed statistically. RESULTS There were 80 HFS patients with mean age of 56.3+/-11.1 (S.D.) years (range 35 to 81), consisting of 54 (67.5%) females, 26 (32.5%) males. The intraclass correlation coefficient (ICC) and Cronbach's alpha were more than 0.7 for the majority of the items and subscales, respectively. There was a good positive correlation of severity of HFS with the subscale scores. Regression analysis of physicians' assessment of response to BTX on change in scores from baseline as rated by patients demonstrated a significant correlation. CONCLUSIONS We demonstrated validity, reliability and sensitivity of the HFS-30 questionnaire. BTX improves quality of life in HFS.
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Affiliation(s)
- Eng-King Tan
- Department of Neurology and Clinical Research, Singapore General Hospital, Outram Road, Singapore.
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Tan NC, Tan EK, Khin LW. Diagnosis and misdiagnosis of hemifacial spasm: a clinical and video study. J Clin Neurosci 2004; 11:142-4. [PMID: 14732372 DOI: 10.1016/j.jocn.2003.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Early recognition of hemifacial spasm (HFS) is important as it can be effectively treated. 203 family physicians participated in a video "test" on HFS. Only 9.4% (19/203) were able to diagnose HFS. 94 (46.3%) of them did not know how to manage the condition. Twenty-two (10.8%) would use steroids as a treatment and 13 (6.4%) felt no treatment was needed. Only 27 (13.3%) indicated that botulinum toxin could be employed to treat HFS. The year of graduation of the doctors significantly correlated with a correct diagnosis (P<0.05). The low positive diagnostic rate (25.7%) of HFS from referrals to the movement disorder clinic corroborated findings from the video test.
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Affiliation(s)
- N C Tan
- SingHealth Polyclinics-Pasir Ris, Singapore
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