Orbicular synkinesis after facial paralysis: treatment with botulinum toxin

Involuntary lid closure not rarely accompanies aberrant regeneration of nerve fibers after different types of facial paralysis. 23 patients with such synkinesis were treated with botulinum toxin injections into the orbicularis oculi muscle. After periocular injections all patients showed much improvement: a period of, on the average, 13 symptom-free weeks was followed by a period of minimal symptoms. There were only minor complications. Whenever repeated treatment is necessary, botulinum toxin proves to be an effective therapy for involuntary lid closure after defective healing following facial paralysis.

[Electrophysiologic studies of the pattern of lesions of mimetic muscles in Bell's palsy]

This paper reports on 379 investigations of patients with the diagnosis of Bell's palsy. The computerized analysis was carried out retrospectively with the programme FANDOS (6). In most electrophysiological measurements five standard muscles (frontalis muscle, orbicularis oculi muscle, levator labii muscle, zygomaticus muscle, orbicularis oris muscle) were investigated with electromyography (EMG); further, neuromyography was performed. In 77.3% of the cases electromyographically incomplete and 22.7% complete palsies were found. The distribution of the reduced innervation patterns and the degeneration of the muscles did not show a preferred lesion of certain muscles. In about sixty per cent of all cases in at least four muscles a homogeneous electromyographic pattern of the lesion in the mimic musculature could be detected. Degeneration potentials, however, were mostly found in one muscle only. In order to provide a differentiated analysis of the electromyographical state of a facial paresis an "EMG-index" was introduced that allows a general judgement of the "degree of palsy" in all five investigated muscles. An analysis of the time dependence of the "EMG-index" over the course of two weeks following onset of the palsy showed no variation during this time period. This proves that the complete status of the palsy is reached early after onset and that a deterioration or improvement is rarely seen within this time interval.

[Involuntary lid closure caused by defective healing of facial paralysis and its treatment with botulinum toxin]

Unvoluntary lidclosure with movement of the mouth is not so rare in aberrant regeneration of nerve fibers after Bell's palsy. There was no therapy until now. 10 patients with this disease were treated with botulinum-toxin injections into the orbicularis muscle. For an average time of 11 weeks after injection there was a complete absence of synkinesis, followed by a time of 9 weeks of less complaints. Thus 2-3 injections might be sufficient treatment within a year. Complications worth mentioning, especially due to the reduced force of lidclosure, were not observed.

[Magnetic stimulation in patients with essential blepharospasm]

In 31 patients with an essential blepharospasm investigations were undertaken with transcranial cortical and cisternal magnetic stimulation of the facial nerve. Cortical stimulation was performed contralaterally, whereas cisternal stimulation was ipsilateral; the latencies and amplitudes of the potentials were determined. However, the extracranial part of the facial nerve was stimulated in the region of the stylomastoid foramen for neuromyography electrically. In most measurements the response potentials in the orbicularis oculi muscle and the levator labii muscle were determined. Cisternal stimulation yielded normal latencies, whereas cortical stimulation showed an increase of latency in some blepharospasm patients. A difference between the orbicularis oculi muscle and the levator labii muscle as known in patients with hemifacial spasm (20) could not be observed. The mean values of all latencies after cortical stimulation were normal. The method of transcranial magnetic stimulation is an important part of the complete investigation of patients with facial hyperkinesias as shown here in blepharospasm patients.

Hexadecylphosphocholine: determination of serum concentrations in rats

A sensitive and quantitative determination of the concentration of hexadecylphosphocholine in serum is described. After HPLC separation, the concentration of hexadecylphosphocholine is determined by phosphate analysis. According to this method, the half-life of hexadecylphosphocholine in serum rats is about 96 h. A steady-state serum concentration of 110 microM is reached after 2 weeks of daily treatment with 10 mg/kg hexadecylphosphocholine. The described method has general application for other compounds with similar structures. For instance, serum levels of alkyllysophosphocholines such as 1-0-octadecyl-2-0-methyl- racglycero-3-phosphocholine can be determined using this method.

The effects of botulinum toxin on hemifacial spasm: an electrophysiologic investigation

Forty-one patients with unilateral or bilateral facial spasm were studied by electrophysiologic examination. All patients received local treatment with botulinum toxin. In the patients and controls, the measurements of the blink reflex revealed changes that (1) may indicate a central origin of the spasm in some cases, and (2) make it likely that the trigeminal nerve influences the facial nucleus and is thus involved in the regulation of the spasm.

[Botulinum toxin treatment of synkinesia following facial paralysis]

We report ten patients with unilateral synkinesias after facial palsy treated with botulinum toxin injections. All patients suffered from extensive mass movements around the eye. After periocular injections all patients showed much improvement: a period of 11 weeks free of symptoms was followed by a 9-week period of minimal symptoms. There were no important complications. The use of botulinum toxin injections is an effective therapy for mass movements after defect healing of facial palsy.

[Magnetic stimulation in patients with facial hemispasm]

A total of 28 patients with a hemifacial spasm were examined using transcranial magnetic stimulation. The potentials were evoked cortically and cisternally; latencies and amplitudes of each potential were measured in the levator labii muscle and in the orbicularis oculi muscle. After cortical stimulation, differences in latencies were found between the healthy and the diseased side of the levator labii muscle. Prolonged latencies were measured more frequently on the diseased side (cortical stimulation). The method of magnetic stimulation is an important addition to electrophysiological diagnostic procedures in facial hyperkinesias. Cortical stimulation combined with measurements of the blink reflex and neuromyography may allow separate parts of the route of the whole facial nerve and supranuclear structures to be examined.

[Relevance of combined electrodiagnosis in facial hyperkinesia]

We present a combined electrophysiological diagnostic procedure for patients with facial hyperkinesia. With the new method of magnetic stimulation a central cortical stimulation is possible to represent the total way of the facial nerve. The combination of magnetic stimulation with other methods such as the blink reflex may lead to topodiagnostic statements in facial hyperkinesias.

[Hydroxyethyl starch in the treatment of Bell's facial paralysis. A clinical study]

Nowadays an infusion therapy composed of cortisone, low-molecular dextran, and pentoxifylline is the most common treatment of Bell's palsy. During recent years it has become well known that low-molecular dextran has several severe side effects (e.g. acute renal failure). - At the ENT Department of the University of Göttingen 33 patients with Bell's palsy were treated with an infusion therapy which replaced low-molecular dextran by hydroxyethyl starch. Before and after therapy patients underwent a special diagnostic procedure for the facial nerve function consisting of --determination of the degree of paralysis and secondary defects (14) --a complete electrophysiological examination. The patients were followed up for at least 6 months. It was found that 97% of the patients had a complete functional recovery.

[FANDOS--a new standardized computer-assisted documentation and evaluation of diseases of the facial nerve]

The personal computer program package FANDOS (Facial Nerve Documentation System) has been designed especially for diseases of the facial nerve. It provides a very simple and exact method of documentation; it does not require much time and is easy to handle. In the ENT department of the University of Göttingen, this program has been tested in the clinical routine. In this paper we present the program package and explain its use in prospective studies.

[Essential blepharospasm and botulinum toxin. An electrophysiologic study]

Thirty-five patients with essential blepharospasm were investigated electrophysiologically after local treatment with subcutaneous periocular injections of botulinum toxin. In all patients the blink reflex was measured on both sides. The results showed in some cases reproducible changes in the reflexes, indicating a central supranuclear origin for the spasm. Furthermore, an influence of afferent information on the "spasm threshold" via the trigeminal nerve is suggested.

[The trigemino-facial reflex in patients with essential blepharospasm. A contribution to the etiology of the disease picture]

We conducted electrophysiological investigations in altogether 11 patients with an essential blepharospasm. In all patients the blink reflex - ipsi- and contralateral - was measured. We found reproducible pathologic changes (direct R1/R2 transition, contralateral early component with and without direct transition into the R2-component, increase of R2-duration). These findings point to a central genesis of blepharospasm in some cases.

Hexadecylphosphocholine, a new ether lipid analogue. Studies on the antineoplastic activity in vitro and in vivo

Hexadecylphosphocholine (He-PC) is a new compound synthesized according to the minimal structural requirements deducted from studies with other ether lipids. In vitro studies on He-PC revealed remarkable antineoplastic activity on HL60, U937, Raji and K562 leukemia cell lines. In addition, He-PC, applied orally, showed a superior effect in the treatment of dimethylbenzanthracene-induced rat mammary carcinomas when compared to intravenously administered cyclophosphamide. After oral application He-PC was well absorbed from the intestine and metabolized in the liver by phospholipases C and D. During a 5-week treatment no hematotoxic effects were detected. In a clinical pilot study on breast cancer patients with widespread skin involvement, topically applied He-PC showed skin tumor regressions without local or systemic side effects.

Distribution and metabolism of hexadecylphosphocholine in mice

Distribution and metabolic fate of radiolabeled hexadecylphosphocholine (He-PC) has been studied in mice. It is demonstrated that He-PC is well-absorbed from the intestinal tract, intravenous (IV) and oral administration lead to similar distributions throughout the body, the highest accumulation of radioactivity occurs in liver, lung and kidney, and the metabolic products are radioactive choline, phosphocholine and 1,2-diacylphosphatidylcholine. The occurrence of these metabolites indicates that phospholipases C and D may be involved in He-PC breakdown.

[Diagnostic and prognostic significance of electromyography in laryngeal movement disorders]

Electromyography of the larynx has been increasingly used during recent years in the diagnosis and differential diagnosis of laryngeal motility disorders. The method is routinely employed at the university ENT department in Göttingen. The qualitative experience gained with regard to the diagnostic and prognostic value of electromyography in the region of the larynx is described and compared with the results and experience reported so far in the literature.