Factors affecting the quality of life in hemifacial spasm patients

Interrater reliability of motor severity scales for hemifacial spasm

To compare the inter-rater reliability (IRR) of five clinical rating scales for video-based assessment of hemifacial spasm (HFS) motor severity. We evaluated the video recordings of 45 HFS participants recruited through the Dystonia Coalition. In Round 1, six clinicians with expertise in HFS assessed the participants' motor severity with five scales used to measure motor severity of HFS: the Jankovic rating scale (JRS), Hemifacial Spasm Grading Scale (HSGS), Samsung Medical Center (SMC) grading system for severity of HFS spasms (Lee's scale), clinical grading of spasm intensity (Chen's scale), and a modified version of the Abnormal Involuntary Movement Scale (Tunc's scale). In Round 2, clinicians rated the same cohort with simplified scale wording after consensus training. For each round, we evaluated the IRR using the intraclass correlation coefficient [ICC (2,1) single-rater, absolute-agreement, 2-way random model]. The scales exhibited IRR that ranged from "poor" to "moderate"; the mean ICCs were 0.41, 0.43, 0.47, 0.43, and 0.65 for the JRS, HSGS, Lee's, Chen's, and Tunc's scales, respectively, for Round 1. In Round 2, the corresponding IRRs increased to 0.63, 0.60, 0.59, 0.53, and 0.71. In both rounds, Tunc's scale exhibited the highest IRR. For clinical assessments of HFS motor severity based on video observations, we recommend using Tunc's scale because of its comparative reliability and because clinicians interpret the scale easily without modifications or the need for consensus training.

Altered Cortical-Striatal Network in Patients With Hemifacial Spasm

Objective: Hemifacial spasm (HFS) is a kind of motor disorder, and the striatum plays a significant role in motor function. The purpose of this study was to explore the alterations of the cortical-striatal network in HFS using resting-state functional magnetic resonance imaging (fMRI). Methods: The fMRI data of 30 adult patients with primary unilateral HFS (15 left-side and 15 right-side) and 30 healthy controls were collected. Six subregions of the striatum in each hemisphere were selected for functional connectivity (FC) analysis. One-sample t-test was used to analyze the intragroup FC of the HFS group and the control group. Two-sample t-test was used to compare the difference of FC between the two groups. The correlation between the abnormal FC and severity of HFS was evaluated by using the Spearman correlation analysis. Results: Compared with the controls, the striatal subregions had altered FC with motor and orbitofrontal cortex in patients with HFS. The altered FC between striatal subregions and motor cortex was correlated with the spasm severity in patients with HFS. Conclusion: The FC of the cortical-striatal network was altered in primary HFS, and these alterations were correlated with the severity of HFS. This study indicated that the cortical-striatal network may play different roles in the underlying pathological mechanism of HFS.

Strengthened thalamoparietal functional connectivity in patients with hemifacial spasm: a cross-sectional resting-state fMRI study

OBJECTIVE

In spite of the well-known importance of thalamus in hemifacial spasm (HFS), the thalamic resting-state networks in HFS is still rarely mentioned. This study aimed to investigate resting-state functional connectivity (FC) of the thalamus in HFS patients and examine its association with clinical measures.

METHODS

25 HFS patients and 28 matched healthy controls underwent functional MRI at rest. Using the left and right thalamus as seed regions respectively, we compared the thalamic resting-state networks between patient and control groups using two independent sample t-test.

RESULTS

Compared with controls, HFS patients exhibited strengthened bilateral thalamus-seeded FC with the parietal cortex. Enhanced FC between right thalamus and left somatosensory association cortex was linked to worse motor disturbance, and the increased right thalamus-right supramarginal gyrus connection were correlated with improvement of affective symptoms.

CONCLUSION

Our findings indicate that the right thalamus-left somatosensory association cortex hyperconnectivity may represent the underlying neuroplasticity related to sensorimotor dysfunction. In addition, the upregulated FC between the right thalamus and right supramarginal gyrus in HFS, is part of the thalamo-default mode network pathway involved in emotional adaptation.

ADVANCES IN KNOWLEDGE

This study provides new insights on the integrative role of thalamo-parietal connectivity, which participates in differential neural circuitry as a mechanism underlying motor and emotional functions in HFS patients.

Orbicularis Oculi Morphological Alterations in Affected and Nonaffected Sides in Hemifacial Spasm

BACKGROUND

Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty.

METHODS

Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses.

RESULTS

When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied.

CONCLUSIONS

Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.

Evaluation of stigmatization in hemifacial spasm and quality of life before and after botulinum toxin treatment

Hemifacial spasm (HFS) is a chronic disease that is characterized by involuntary tonic and clonic contractions of the muscles innervated by the ipsilateral facial nerve. Botulinum toxin (BTX) is the most effective medical treatment of this condition. The aim of our study was to evaluate stigma among patients diagnosed with HFS and to search quality of life and depression before and after BTX injection. Seven self-rating items (HFS-7) and seven questions related to stigmatization were administered to HFS patients. Participants also answered SF-36 health outcome measure and Beck depression inventory before and 4 weeks after the routine BTX injection. The severity of HFS was graded based on a five-point scale. Descriptive statistics and paired t test were applied. The level of significance was set at α = 0.05. Fourty HFS patients were prospectively included. Twenty-one (%52.5) were female and nineteen were male (47.5%) with a mean age of 57.1 (SD = 12.13; min-max = 27-78). 60% (n: 24) of patients were feeling themselves different from people without HFS. Beck depression inventory scores improved after BTX injection significantly (p < 0.05). All domains of SF-36 showed positive improvement after BTX injections. The improvement in general health perception, physical functioning, and vitality was statistically significant (p < 0.05). Although more than half of the patients felt themselves different from people without HFS, treatment of HFS with BTX significantly improved mental health and physical health, and depressive symptoms of the patients.

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

Background and Purpose

Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD).

Methods

We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups.

Results

The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD.

Conclusions

Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.

An investigation into quality of life improvement in patients undergoing microvascular decompression for hemifacial spasm

OBJECTIVE Hemifacial spasm (HFS) is a movement disorder characterized by involuntary spasms of the facial muscles, and it can negatively impact quality of life (QOL). This retrospective study and systematic review with meta-analysis was conducted to investigate the QOL in patients with HFS following intervention with microvascular decompression (MVD) and botulinum toxin (BT). METHODS In the retrospective analysis, a QOL questionnaire was administered to all patients undergoing MVD performed by a single surgeon. The QOL questionnaire included unique questions developed based on the authors' experience with HFS patients in addition to the health-related QOL HFS-8 questionnaire. The authors also report on a systematic review of the English literature providing outcomes and complications in patients with HFS undergoing treatment with either MVD or BT. RESULTS Regarding the retrospective analysis, 242 of 331 patients completed the questionnaire. The mean score of the 10 QOL questions improved from 22.78 (SD 9.83) to 2.17 (SD 5.75) following MVD (p < 0.001). There was significant improvement across all subscales of the questionnaire between pre- and postoperative responses (p < 0.001). Regarding the systematic review, it is reported that approximately 90% of patients undergoing MVD for HFS experience a complete recovery from symptoms, whereas the mean peak improvement of symptoms following treatment with BT is 77%. Furthermore, patients undergoing MVD reported a greater improvement in the mean supplemental index of QOL as compared with patients receiving BT therapy. CONCLUSIONS Microvascular decompression offers a significant improvement in QOL in well-selected patients suffering from HFS, and may offer an increased benefit for QOL over BT injections.

Thin-slice T2 MRI imaging predicts vascular pathology in hemifacial spasm: a case-control study

Hemifacial spasm (HFS) is a condition that may severely reduce patients' quality of life. We sought to determine the sensitivity and specificity of thin-slice T2 magnetic resonance imaging (MRI) for detecting vascular compression in HFS patients. Prospective information was collected on 28 patients with HFS who presented to our center between March 2011 and March 2012 with thin-slice T2 MR imaging. The sensitivity and specificity for differentiating patients from controls were calculated. Sensitivities were 78.6% and 92.9% for the blinded radiologists and 75% for the partially blinded neurosurgeon. Specificities were 42.9% and 28.6% for the blinded radiologists and 75% for the partially blinded neurosurgeon. Magnetic resonance imaging of the facial nerve can guide clinicians in selecting patients who are good surgical candidates. Thin-slice T2 MRI should be viewed as supportive rather than diagnostic.