[Clinical aspects and treatment of 95 patients with hemifacial spasm]

Hemifacial Spasm (HFS) is considered a peripheral disease of the facial nerve caused by vascular compression at the nerve root in the pontocerebellar angle. We aimed to study the natural course of HFS and especially, to examine the relationships with psychological status or physical activities, in order to assess the possible role of the facial nucleus in the pathogenesis. Ninety-five consecutive patients with HFS, 52 men and 43 women, with a mean age of 62 + 12.7 years and a mean disease duration of 7.5 + 6.5 years, were personally interviewed by 2 of the authors (SB and HK). A detailed questionnaire was completed with direct and indirect questions regarding the relationship between the severity of the spasms and emotional status or physical activity. We found strong association between emotional stress and tiredness and aggravation of the spasms in 85% and 54% of the patients, respectively. Talking increased the spasm severity in 58% of the patients and eating or drinking aggravated the spasm in 28% of the patients. Physical activity, head position, the season of the year or the time during the day had no effect on the clinical status. Botulinum toxin was injected to 78 patients with an overall subjective rate of improvement of > 70% in 74% of the patients (23% graded their rates of improvement as > 90%). In conclusion, HFS is a movement disorder of the facial nerve which is highly influenced by emotional status to support an involvement of the facial nucleus in the pathogenesis. Botulinum toxin is a very effective long term treatment for this disorder.