Hemifacial spasm: ephaptic transmission or hyperexcitability of the facial motor nucleus?

Hemifacial spasm is a rare disorder that is caused by a blood vessel cross-compressing the facial nerve near the nerve's entry into the brain stem. Electrical stimulation of one branch of the facial nerve on the affected side in patients elicits a response from muscles that are innervated by another branch. Intraoperative recording of this abnormal muscle response, together with measurements of conduction times in parts of the facial nerve, in earlier studies have shown evidence that the cross-transmission of antidromic activity that causes this response occurs central to the site of vascular compression of the facial nerve. In this study we show that in rare circumstances during microvascular decompression operations, a small EMG potential precedes the regular abnormal muscle response. This early response has a latency that is equal to the sum of the conduction times of the portions of the facial nerve that would have been involved if the cross-transmission had occurred at the site of vascular compression of the facial nerve, and it may thus be a result of ephaptic transmission in the nerve at that location. Thus, cross-transmission of antidromic activity can indeed occur in the facial nerve at the site of compression, although we have observed this early potential in only 3 of more than 50 patients who were operated upon for hemifacial spasm; further, in those three patients it occurred only for a short time and only during surgical manipulation of the facial nerve. In view of the fact that this early response occurs only after the nerve has been manipulated, and because it is of such small magnitude, it seems unlikely that such cross-transmission (ephaptic transmission) at the site of the vascular compression plays a direct role in generating the spasm and the antidromic activity that spreads from one branch of the facial nerve to another.