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Decompression Surgery in Elderly Patients with Hemifacial Spasm Refractory to Botulinum Toxin
Margaret Tugend1, Christina M Ulane2, Kevin Patel2
1Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA.
Movement Disorders Clinical Practice
|May 23, 2024
Summary
Botulinum toxin is a common treatment for hemifacial spasm in seniors. Surgical decompression remains effective for those unresponsive to injections, with no impact on future success.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Botulinum toxin is an effective hemifacial spasm treatment for elderly patients.
- Some patients experience intolerable side effects or require frequent treatments.
Purpose of the Study:
- To evaluate characteristics and outcomes of elderly patients undergoing facial nerve decompression after botulinum toxin therapy.
- To identify predictors of spasm-freedom post-surgery.
Main Methods:
- Prospective cohort study of 76 elderly patients with hemifacial spasm.
- Logistic regression analyzed predictors: age, sex, side, symptom duration, and prior botulinum toxin treatments.
- Follow-up of at least 2 years.
Main Results:
- 84.2% of patients achieved spasm-freedom at last follow-up (median 44.5 months).
- No significant predictors for long-term spasm-freedom were identified (age, sex, side, symptom duration, prior treatments).
- The most frequent complication was permanent ipsilateral hearing loss (3.9%).
Conclusions:
- Elderly patients can receive botulinum toxin for hemifacial spasm without compromising future surgical decompression outcomes.
- Surgical decompression is an effective therapy for elderly patients with botulinum toxin-refractory hemifacial spasm.
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