Profile of patients with essential blepharospasm and hemifacial spasm in the two largest ophthalmology reference centers in Brazil.

PURPOSE: Information is scarce regarding the comprehensive profile of patients with essential blepharospasm and hemifacial spasm in Brazil. The present study aimed to assess the clinical features of patients with these conditions, followed up in two reference centers in Brazil. METHODS: The study included patients with essential blepharospasm and hemifacial spasm, followed up at the Departments of Ophthalmology at Universidade Federal de São Paulo and Universidade de São Paulo. Apart from demographic and clinical features, past stressful events related to the first symptoms (triggering event), aggravating factors, sensory tricks, and other ameliorating factors for the eyelid spasms were assessed. RESULTS: A total of 102 patients were included in this study. Most patients were female (67.7%). Essential blepharospasm was the most frequent movement disorder [51/102 patients (50%)], followed by hemifacial spasm (45%) and Meige's syndrome (5%). In 63.5% of the patients, the onset of the disorder was associated with a past stressful event. Ameliorating factors were reported by 76.5% of patients; 47% of patients reported sensory tricks. In addition, 87% of the patients reported the presence of an aggravating factor for the spasms; stress (51%) was the most frequent. CONCLUSION: Our study provides information regarding the clinical features of patients treated in the two largest ophthalmology reference centers in Brazil.

Prospective, Multicenter Clinical Study of Microvascular Decompression for Hemifacial Spasm.

BACKGROUND: Microvascular decompression (MVD) is the most effective procedure for hemifacial spasm (HFS). MVD results from nonspecialized or low-volume institutes are not always reliable. Most studies on MVD for HFS are retrospective and single centered; to the best of our knowledge, no prospective, multicenter studies exist. OBJECTIVE: To evaluate short- and long-term outcomes and complications in patients who underwent MVD for HFS in specialized Japanese institutions, in this multicenter, prospective, cohort study. METHODS: Included patients had undergone MVD for HFS in study centers between April 2012 and March 2015. Patients' postoperative grade of involuntary movements and complications were recorded postoperatively at 7 d (short-term) and at 1 (mid-term) and 3 (long-term) yr. RESULTS: A total of 486 patients (150 men, 336 women; mean age 53.9 yr with 181 patients over 60 yr) were enrolled during the study period. Neuromonitoring was used in 96.3% of the cases. The complete cure rate of symptom relief, mortality rate, and complication rate at short-term follow-up were 70.6%, 0%, and 15%, respectively. The long-term follow-up was completed by 463 patients (95.3%); the complete cure rate of symptom relief and complication rate were 87.1% and 3.0%, respectively. CONCLUSION: Our study revealed that under expert guidance and intraoperative neuromonitoring, the long-term curative effect rate of MVD for HFS is high, while complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with HFS, including elderly patients.

Role of neuroimaging in cases of primary and secondary hemifacial spasm.

Purpose: The objective of this study was to analyze the role of neuroimaging and documenting various intracranial pathologies in primary and secondary hemifacial spasm. Methods: This retrospective study included patients with HFS who had undergone neuroimaging. The demographic profile, onset, progression, neuroimaging findings, and types of HFS were documented and analyzed. Results: A total of 202 patients (male = 110, female = 92) were included. The mean age of the study population was 51.81 ± 11.76 years. The right side was involved in 104 patients, the left side was involved in 97 patients and bilateral involvement was observed in one patient. Primary HFS: secondary HFS was 9.6:1. The mean age of onset of the spasms in the primary HFS group was 49.26 ± 8.35 years and in secondary HFS was 43.13 ± 12.12 years respectively. The anterior inferior cerebellar artery was the major vessel causing neurovascular conflict in primary HFS (n = 55). Facial nerve palsy was the most common cause (n = 13) of secondary HFS followed by cerebellopontine angle (CPA) tumors. Conclusion: The hemifacial spasm occurs mostly in the fifth decade of life. Primary HFS is more prevalent than secondary HFS. Clinical distinction between them is difficult. Neuroimaging is essential to detect the conflicting vasculature in cases of primary HFS and pathologies like CPA tumor, cyst, and aneurysms in cases of secondary HFS.

[Hemifacial spasm. Etiology and management]. / Spasmes hémifaciaux. Étiologies et conduite à tenir.

INTRODUCTION: Hemifacial spasm (HFS) is an involuntary contracture of the facial muscles innervated by the ipsilateral facial nerve. We studied the etiology of these HFS. MATERIALS AND METHODS: This retrospective study included 233 patients with HFS who came to the ophthalmologist for quarterly botulinum neurotoxin A injection. Of these, we analyzed the 198 patients for whom MRI scans were performed. We recorded patient clinical data and clarified the etiology of their HFS. RESULTS: The 198 patients (62.6% women) had a mean age of 55.7±14years. An etiology was found in 52.5% of cases. In 34.5% of HFS, MRI revealed vascular compression where the facial nerve emerged from the brainstem. We specify the arteries involved. Brain tumors accounted for 1.5% of cases. MRI was normal in 64.5% of cases. In these secondary cases of HFS, we found 8.5% peripheral facial palsy, 4% post-traumatic HFS and 4% secondary to an eye injury. Stress was found in 17% of patients. DISCUSSION AND CONCLUSION: This study illustrates the need for MRI with attention to the posterior fossa in the work-up of HFS in order to identify primary HFS associated with vascular compression of the facial nerve and to rule out a rare but serious posterior fossa tumor. The treatment of HFS is based on quarterly injections of botulinum neurotoxin/A (NTBo/A), the three brands of which have market approval. The injection pattern and frequency is customized according to the results. In cases of insufficient response to injections of NTBo/A, neurosurgical microvascular decompression may be considered for cases of primary HFS.

The Epidemiology, Cause, and Prognosis of Painful Tic Convulsif Syndrome: An Individual Patient Data Analysis of 192 Cases.

BACKGROUND: Characterized by the coexistence of trigeminal neuralgia and ipsilateral hemifacial spasm (HFS), painful tic convulsif (PTC) is a rare entity that has not yet been systematically studied. OBJECTIVE: To systematically explore the epidemiology, cause, prognosis, and prognosis predictors of PTC. METHODS: We searched PubMed, Web of Science, and the Cochrane Library for relevant studies published between establishment of the library and July 1, 2020. Information on demographics, causes, specific interventions, and intervention outcomes was extracted. We first performed descriptive analysis of demographics, causes, and surgical outcomes of PTC. Univariate and multivariate regression methods were used to explore potential prognosis predictors. Further, a 2-step meta-analysis method was used to validate the identified factors. RESULTS: Overall, 57 reports including 192 cases with PTC were included in the analysis. The median age of patients with PTC is 54 years (range, 44-62 years), with more patients being female (P < 0.001), initiated as HFS (P = 0.005), and being affected with left side (P = 0.045). The vertebrobasilar artery contributes to >65% of the causes of single vascular compression for PTC. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement (odds ratio, 4.050; 95% confidence interval, 1.091-15.031) and older age (P = 0.008) predict freedom from symptoms and recurrence after microvascular decompression, respectively. CONCLUSIONS: PTC occurs more in middle-aged women between 40 and 60 years old, initiates as HFS, and affects the left side. Vertebrobasilar artery compression is the most common single cause of PTC. Microvascular decompression effectively treated PTC, with a cure rate >80%. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement predicts successful surgery and older age predicts recurrence.

Microvascular decompression in patients with hemifacial spasm.

PURPOSE: To study blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS). METHODS: A retrospective study was performed to review HFS patients who received MVD surgery between January 2014 and December 2016. Vessels that were considered to be responsible for HFS were determined by reviewing the brain magnetic resonance imaging, magnetic resonance angiography, and surgical video. Blood pressure measurements were performed 1 day before (preoperative) and 7 days after (postoperative) the MVD surgery. Pre- and postoperative blood pressure measurements were compared. RESULTS: A total of 374 patients were included in the study, with 118 (31.6%) male patients, age 53.8 ± 9.9 years old, and 141 (37.7%) patients with hypertension. Systolic blood pressure had statistically significant decrease in patients with (134.5 ± 8.2-132.6 ± 9.1 mmHg, p = .01) or without (125.6 ± 9.1-123.8 ± 10.0 mmHg, p = .01) hypertension. Diastolic blood pressure only had statistically significant decrease in patients with hypertension (83.0 ± 5.8-82.0 ± 6.5 mmHg, p = .04). Analyses in all the study patients and in the subgroup of patients with hypertension showed that more statistically significant blood pressure reductions were observed when left-side vessel or vertebrobasilar artery was involved. CONCLUSION: In patients with HFS, MVD not only decreased blood pressure in patients with hypertension but also affected blood pressure in patients without hypertension. Blood pressure reductions were more prominent when left-side vessel or vertebrobasilar artery was involved.

Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada.

BACKGROUND: We aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS). METHODS: The CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay. Descriptive statistics were generated. Provincial utilization rates of MVD for HFS were calculated. RESULTS: During the period 2004-17, we identified 671 MVDs performed for HFS at 20 centers across Canada. During the study period, 286 MVDs (42.6%) were performed at one center in Manitoba. Another 131 (19.5%) and 72 (10.7%) were performed at one center in British Columbia and Ontario, respectively. The remaining 182 (27.1%) MVDs for HFS were performed at 17 centers across the rest of Canada where the mean number of cases performed per year was 1.1 (SD=0.9, range 0.2-2.9). When out-of-province cases were re-allocated to place of residence, the adjusted provincial utilization of MVD for HFS ranged between 0.5 and 6.1 patients per million per year. CONCLUSIONS: Microvascular decompression for HFS is performed relatively rarely and there is a tremendous geographic variation in utilization across Canada. Although most of these surgeries are performed by a few surgeons, more than half of Canadian centers perform an average of less than 1 case per year. Further examination of the impact of these discrepancies appears warranted.

Disparités géographiques dans la prise en charge chirurgicale du spasme hémifacial au Canada. CONTEXTE: Nous avons voulu interroger la base de données de l'Institut canadien d'information sur la santé (ICIS) afin de déterminer la répartition géographique et les résultats de la décompression vasculaire microchirurgicale (DVMC) dans le traitement du spasme hémifacial. MÉTHODES: Notre recherche a porté sur les années 2004 à 2017 et visait, au moyen de la base de données de l'ICIS, à repérer des diagnostics et des codes d'acte pertinents. Une nouvelle base de données a été ensuite alimentée en fonction des catégories suivantes : l'année de l'intervention, l'établissement concerné, la province, le nombre d'interventions par année et la durée moyenne de séjour des patients. C'est à partir de cette nouvelle base de données que des statistiques descriptives ont été produites. À cet égard, nous avons calculé les taux provinciaux d'utilisation de la DVMC pour traiter le spasme hémifacial. RÉSULTATS: Au cours de la période allant de 2004 à 2017, nous avons identifié 671 interventions de DVMC dans 20 établissements de santé situés partout au Canada. Durant cette période d'étude, 286 interventions de DVMC (42,6 %) ont été réalisées dans un seul établissement du Manitoba tandis que 131 autres (19,5 %) et 72 autres (10,7 %) ont été respectivement réalisées dans un seul établissement de la Colombie-Britannique et de l'Ontario. Quant aux 182 (27,1 %) autres interventions, elles ont été réalisées dans 17 établissements du reste du pays où le nombre moyen d'interventions par année était de 1,1 (σ = 0,9; étendue = 0,2 ­ 2,9). Une fois réassignés les cas de patients provenant d'autres provinces, et ce, en fonction de leurs lieux de résidence, l'utilisation ajustée par province de la DVMC variait, sur une base annuelle, de 0,5 à 6,1 patients par million. CONCLUSIONS: Les interventions de DVMC pour traiter le spasme hémifacial sont réalisées peu fréquemment. Il existe aussi une énorme variation géographique au Canada quant à l'utilisation de cette technique chirurgicale. Bien que la plupart de ces interventions soient effectuées par quelques chirurgiens, plus de la moitié des établissements de santé canadiens concernés effectuent en moyenne moins d'une intervention par année. Un examen plus approfondi de l'impact de ces écarts semble ainsi se justifier.

Epidemiology of benign essential blepharospasm: A nationwide population-based retrospective study in Taiwan.

IMPORTANCE: This study provides a nationwide, population-based data on the incidence of benign essential blepharospasm in Asian adults. BACKGROUND: To describe the incidence, patient demographics, and risk factors associated with benign essential blepharospasm. DESIGN: Population-based retrospective study. PARTICIPANTS AND SAMPLES: A total of 1325 patients with benign essential blepharospasm were identified. METHODS: Patients with diagnosis of blepharopsasm between January 2000 and December 2013 were sampled using the Longitudinal Health Insurance Database 2000. Secondary blepharospasm that may be related to neurological, trauma, and ocular surface disease were excluded. MAIN OUTCOME MEASURED: Multivariate conditional logistic regression was used to estimate the odds ratios for potential risk factors of benign essential blepharospasm. RESULTS: The mean annual incidence was 0.10‰ (0.07‰ for males, and 0.12‰ for females). The peak incidence was in the 50 to 59-year-old age group (0.19‰). People living in urban regions have more risk of developing blepharospasm comparing to people living in less urban regions (p <0.01). White-collar workers also have higher chance of having blepharospasm (p<0.001). Significant difference between control group and case group in hyperlipidemia (p <0.001), sleep disorders (p <0.001), mental disorders (depression, anxiety, obsessive compulsive disorder) (p <0.001), dry eye-related diseases (dry eye, Sjögren's syndrome) (p <0.001), Parkinson's disease (p <0.004), and rosacea (p <0.021) were also identified. CONCLUSIONS AND RELEVANCE: Higher level of urbanization, white-collar work, sleep disorders, mental health diseases, dry eye-related diseases, Parkinsonism, and rosacea are possible risk factors for benign essential blepharospasm.

Outcome of Biomedical Glue Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery.

BACKGROUND: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). In cases of vertebral artery (VA) compression of the facial nerve, MVD is often difficult. In this study, we compared the outcome of the biomedical glue sling technique with the traditional technique in MVD for HFS involving the VA. METHODS: A retrospective study of patients with HFS treated by MVD was conducted between January 2013 and December 2015. A total of 327 patients with VA-associated HFS underwent their first MVD at our institution. Among them, the traditional technique was performed in 153 patients and the biomedical glue sling technique was performed in 174 patients. We measured effectiveness at 1 day, 7 days, 1 month, 3 months, and 1 year after MVD surgery. RESULTS: In the traditional technique group, the effective rates of MVD were 89.54%, 88.89%, 89.40%, 88.44%, and 86.71%, and the incidence rates of complication were 5.23%, 4.58%, 3.97%, 2.72%, and 0.70%. In the biomedical glue sling technique group, the effective rates of operation were 96.55%, 96.55%, 97.66%, 95.86%, and 95.76% (P < 0.05), and the incidence rates of complication were 8.62%, 8.62%, 7.60%, 4.73%, and 2.42% (P > 0.05). CONCLUSION: When the HFS were associated with the VA, the effective rate of biomedical glue sling technique of MVD was higher than the traditional technique, and there was no statistical difference between the 2 groups about the incidence of complication.

The Current Status of Microvascular Decompression for the Treatment of Hemifacial Spasm in Japan: An Analysis of 2907 Patients Using the Japanese Diagnosis Procedure Combination Database.

Microvascular decompression (MVD) is widely used as a safe and effective treatment for hemifacial spasm (HFS). However, the extent of application of this therapeutic method and its outcomes in Japan are currently unclear. To address these questions, we analyzed the utilization of MVD for the treatment of HFS during the 33- month period from July 2010 to March 2013. We conducted an analysis on data contained in the Diagnosis Procedure Combination database in Japan. This analysis showed that MVD was used for the treatment of HFS in 2907 cases (men, 916; women, 1991) with 2.2 times more women treated than men. MVD for HFS was most frequently performed in women aged 50 to 69 years; however, most men were aged between 40 and 59 years at the time of the procedure. The numbers of procedures performed per 100,000 population/year were 0.83 overall in Japan, with the numbers larger in prefectures with larger populations. Regarding discharge outcomes, the mortality rate was 0.1%. The mean length of hospital stay in patients undergoing MVD for HFS was 14.7 days. This analysis provides preliminary information regarding the trends in the performance of MVD for the treatment of HFS in Japan. Further studies on other registries that contain data obtained by standardized assessment methods and that include long-term outcomes and postoperative complications are required.

Five-Year Retrospective Review of Cases with Benign Essential Blepharospasm and Hemifacial Spasm Presenting in a Tertiary Eye Care Center in North India.

Retrospective analysis of epidemiological and clinical characteristics of patients diagnosed with benign essential blepharospasm and hemifacial spasm who reported to the oculoplasty clinic of a tertiary eye care center in north India between January 2010 and April 2015 was carried out. Dry eye, as well as all the local factors that can cause blepharospasm or hemifacial spasm, was ruled out. Systemic evaluation was done to rule out any neurological disorder. A detailed history was taken to rule out any associated psychiatric disorders as well as use of any medication which could be responsible for dystonic movements. In every patient of hemifacial spasm, magnetic resonance imaging (MRI) of the brain was done for any facial nerve compression or tumor involving posterior fossa. Botulinum type A injections were given after assessing their requirements on the basis of guidelines given by Jankovic et al.

The association between vertebrobasilar dolichoectasia and hemifacial spasm.

BACKGROUND: Hemifacial spasm (HFS) is frequently caused by vascular compression of the facial nerve. Vertebrobasilar dolichoectasia (VBDE) may cause vascular crowding in the limited space of the posterior fossa, increasing the chance of vascular compression of the facial nerve. We investigated the prevalence of VBDE in HFS. METHODS: We analyzed the presence of VBDE on 3.0 T magnetic resonance images in patients with HFS and control subjects; age, sex and hypertension were matched. Two blinded readers independently assessed the images. We evaluated the vascular risk factors, including diabetes mellitus, hyperlipidemia, ischemic heart disease, stroke, and presence of lacunes. RESULTS: A total of 310 patients with HFS and 310 control subjects were included. The prevalence of VBDE was higher in patients with HFS (48/310, 15.5%) than in controls (10/310, 3.2%), with an odds ratio (OR) of 5.82 (P < 0.001). Among patients with HFS, the presence of facial nerve compressing vessels was more frequent in dolichoectasia-positive patients (87.5%) than in dolichoectasia-negative patients (58.4%) (OR: 4.99, P < 0.001). Dolichoectasia-positive patients had a higher mean age (58.8 versus 54.8 years, P = 0.03), as well as greater frequency of hypertension (OR: 2.44, P = 0.01) and history of ischemic heart disease (OR: 5.05, P = 0.03) than their dolichoectasia-negative counterparts. CONCLUSIONS: We found that VBDE is associated with HFS in a portion of patients. Since vascular risk factors were more prevalent in dolichoectasia-positive patients, an investigation of VBDE and its risk factors may serve to prevent vascular complications.

Is hypertension a risk factor of hemifacial spasm?

OBJECTIVES: The published data on the relation between arterial hypertension (AH) and hemifacial spasm (HFS) are controversial. The aim of the study was to determine the prevalence of AH in HFS patients and the relation of AH and compression of the brainstem at the region of vasomotor center. MATERIALS AND METHODS: The study included 60 of primary HFS patients and 60 healthy controls matched by age. AH was defined according to WHO criteria. The vessel compression of the brainstem was measure on MRI scans in selected region of vasomotor center located in the ventro-lateral medulla (VLM), between the pontomedullary junction, retro-olivary sulcus and the root entry zone (REZ) of the IX and X nerves. Modeling and compression severity of the VLM was graded in the 0-3 scale. RESULTS: The prevalence of AH in HFS patients did not differ significantly from the control group (61.6% vs 45.0%, p=ns). VML compression by vessel was frequently found in HFS patients with AH than without AH (97.2% vs 60.9%, χ(2)=11.0, p=0.0009). A similar relation was also found in the control group. The higher rate of VML vascular compression was related to the presence of AH in both, HFS patients and control group. CONCLUSION: The prevalence of AH in HFS patients does not differ from controls. The VLM compression in HFS patients and controls is related to AH diagnosis. The association between AH and VLM compression is stronger in patients with higher degree of VLM compression.

Revisiting the link between hypertension and hemifacial spasm.

The relationship between hypertension and hemifacial spasm (HFS) has been debated. Microvascular decompression surgery is effective in some HFS patients with uncontrolled hypertension. To address current gaps in knowledge, we conducted a meta-analysis of case-control studies that have examined the prevalence of hypertension in HFS patients compared to non-HFS controls. We also evaluated the implications and limitations of the pooled studies. We identified 62 studies from PubMed, The Cochrane Library, Web of Science and Scholar.google.com and six studies that fit our inclusion criteria were included. A random-effects model was used to derive the pooled estimate of the Odds Ratio. The data was plotted on a Forest plot. A pooled analysis involving 51585 subjects, 549 cases, 720 neurological controls and 50316 controls from the general population, showed that HFS patients had a higher chance of developing hypertension (OR = 1.72, 95% CI = (1.12, 2.31), p-value <0.001). The prevalence of hypertension was higher in HFS patients as compared to non-HFS patients. This meta-analysis highlights a positive correlation between hypertension and HFS. Blood pressure should be closely monitored during the follow-up of HFS patients. Preliminary links between ventrolateral medullary (VLM) compression and HFS should be further evaluated in future studies.

Does arteriosclerosis contribute to hemifacial spasm?

BACKGROUND: Hemifacial spasm (HFS) is caused by pulsative vascular compression of the root exit zone (REZ) of the facial nerve. However, the mechanism that causes the offending vessels to compress the REZ has not been clarified. Elongation of intracranial arteries due to arteriosclerosis is one possibility, but such arteriosclerotic changes are not observed very frequently among patients with HFS. The aim of the present study was to investigate whether arteriosclerotic changes would contribute to the pathogenesis of HFS. METHODS: This study included 111 HFS patients, all of whom were Japanese. The prevalence rates of hypertension, hyperlipidemia, and diabetes mellitus were examined as risk factors of atherosclerosis, and the cardio-ankle vascular index (CAVI) was measured as an indicator of arteriosclerotic change. The severity of white matter lesions (WMLs) in HFS patients was measured by magnetic resonance imaging. These data were compared with data from healthy Japanese controls. RESULTS: The prevalence rates of the risk factors for atherosclerosis in the HFS patients were not higher than those in the general Japanese population. The CAVI scores for the HFS patients were similar to, or lower than those in the healthy controls for all age groups except 60 to 69-year-old men. The severity of WMLs in the HFS patients was not significantly worse than that in the controls. CONCLUSIONS: It is suggested that arteriosclerotic changes are not involved in the pathogenesis of HFS, and that vascular compression syndromes are attributable to anatomical features of the intracranial arteries and facial nerves formed during the prenatal stage.

Hemifacial spasm: The past, present and future.

Hemifacial spasm is characterised by unilateral contractions of the facial muscles. Though considered to be benign by many people, it can lead to functional blindness and a poor quality of life due to social embarrassment for the suffering individual. Botulinum toxin therapy is an excellent noninvasive tool to treat this condition. However, surgical decompression of the aberrant vessel is also an upcoming approach to therapy for this condition.

Small volume of the posterior cranial fossa and arterial hypertension are risk factors of hemifacial spasm.

OBJECTIVES: So far, there are only two studies evaluating the relation between the small volume of the posterior cranial fossa (VPCF) and the occurrence of HFS, both on Asian population. The aim of the study was to determine small VPCF and arterial hypertension (AH), as risk factors for hemifacial spasm (HFS) and their relation to neurovascular conflict (NVC) in Polish Caucasian-origin patients. MATERIALS AND METHODS: The study included 60 patients with idiopathic HFS and 60 healthy volunteers matched by sex and age. AH was defined according to WHO. The VPCF measured the volume of the prepontine, prespinal and both cerebellopontine angle cisterns in MRI scans. RESULTS: There were no significant differences between occurrence of AH and the VPCF of patients and controls but the mean VPCF in women was significantly smaller than in men, In the multivariate regression analysis model only NVC was the statistically significant. In the subgroup of >50-year-old patients the most dominant risk factor was NVC (OR 71.09; 95% CI 21.08-239.77; p=0.0000), followed by the AH duration (OR 1.07; 95% CI 1.00-1.16; p=0.047). In the subgroup of <50 years, NVC was also the dominant risk factor, followed by the lower VPCF (Walad test: OR 0.4; 95% CI 0.16-1.04; p=0.045). CONCLUSION: There was no significant difference in VPCF and in frequency of AH diagnosis in HFS patients and age- and sex-related controls, but the logistic regression analysis showed that small VPCF and AH duration are risk factors of HFS in younger and older patients respectively.

Hemifacial spasm and neurovascular compression.

Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.

Hypertension in patients with cranial nerve vascular compression syndromes and comparison with a population-based cohort.

OBJECT: Although essential arterial hypertension (AH) represents a major health issue, its underlying causes remain unknown. An intriguing hypothesis is that AH in some cases may be caused by vascular compression of the rostral ventrolateral medulla (RVLM). Because hemifacial spasms (HFSs) are caused by vascular compression of the seventh cranial nerve in close proximity to the RVLM, one would, if this hypothesis is correct, expect to find a positive association between the occurrence of AH and chronic HFSs. Such a positive association would not be expected in patients with trigeminal neuralgia (TN), since TN is caused by vascular compression of the fifth cranial nerve, which is not close to the RVLM. METHODS: In view of this background, the authors conducted a retrospective population-based study to investigate how the occurrence of AH in patients with either HFSs or TN compares with the prevalence of AH in the general population, when adjusted for sex and age. The general population was represented by participants of the Nord-Trøndelag Health Study 3 (HUNT3). RESULTS: The prevalence of AH in the authors' patients with HFSs was significantly higher than in a sex- and age-adjusted sample from the general population; this was not true for the patients with TN. CONCLUSIONS: The authors suggest that the data provide supporting evidence to the theory that compression of the RVLM may be one cause of AH.

Headache in hemifacial spasm patients.

OBJECTIVES: To assess prevalence of headaches in patients with hemifacial spasm. To determine whether hemifacial spasm provokes headaches and identifies predictive factors. To evaluate whether botulinum toxin given for hemifacial spasm improves headaches. METHODS: Seventy patients with hemifacial spasm were evaluated for headaches. The relationship of headaches with hemifacial spasm, impact on quality of life (HIT-6), and improvement in headaches from botulinum toxin was recorded. Data on duration, severity, and impact on quality of life (HFS-7) of hemifacial spasm were collected. RESULTS: Hemifacial spasm-related headache was significantly associated with increased hemifacial spasm severity (P < 0.001) and HIT-6 (P = 0.024). Greater hemifacial spasm severity was predictive of hemifacial spasm-related headache (P = 0.006, OR 19.1, 95% CI 2.35-155.64). Botulinum toxin (BTX) for hemifacial spasm improved hemifacial spasm-related headaches (P < 0.001). CONCLUSIONS: Hemifacial spasm can complicate headaches, particularly in patients with greater hemifacial spasm severity. Individually tailored regimens of botulinum toxin may be indicated in these patients.