Hemifacial spasm is not affected by state of consciousness: a case report.

BACKGROUND:  Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how HFS manifests under disturbance of consciousness. Here, we report a case of primary HFS in which the patient's symptoms persisted in a coma. CASE PRESENTATION: A 74-year-old female with right-sided primary HFS for 20 years and had received botulinum toxin injections in our hospital. Unfortunately she was carried to emergency department after traumatic right pneumothorax by accident. During the emergency treatment, she lost consciousness due to simultaneous cardiac arrest and respiratory arrest. She was then admitted to the emergency intensive care unit for further treatment. During her hospitalization, she was in a coma with stable vital signs and persisting symptoms of HFS. Thus, a multidisciplinary consultation was requested to identify whether it was focal cortical seizures involving the right-side facial muscles. Physical examination revealed brief involuntary clonic or tonic contractions accompanied with the 'Babinski-2 sign'. A combination of relevant data, including her past history, clinical presentation and a negative computed tomography scan of the head, led to a diagnosis of right-sided HFS. As the symptoms of HFS are not life-threatening, the use of anticonvulsants is unnecessary. CONCLUSIONS: For the layperson, it is crucial to seek a multidisciplinary consultation to obtain a correct diagnosis.

Lateral spread response of different facial muscles during microvascular decompression in hemifacial spasm.

OBJECTIVE: Interpreting lateral spread response (LSR) during microvascular decompression (MVD) for hemifacial spasm (HFS) is difficult when LSRs observed in different muscles do not match. We aimed to analyze LSR patterns recorded in both the orbicularis oris (oris) and mentalis muscles and their relationships with clinical outcomes. METHODS: The data of 1288 HFS patients who underwent MVD between 2015 and 2018 were retrospectively reviewed. LSR was recorded in the oris and mentalis muscles through centrifugal stimulation of the temporal branch of the facial nerve after preoperative mapping. The disappearance of LSR following surgery, clinical outcomes, and the characteristics of LSR in oris were analyzed. RESULTS: After surgery, LSR remained in 100 (7.7%) and 279 (21.6%) of the mentalis and oris muscles, respectively. The postoperative outcome correlated with LSR disappearance in the mentalis, not with that in the oris. CONCLUSION: LSR patterns differed in each muscle and may not be correlated with clinical outcomes. LSR in the mentalis and oris muscles should be interpreted differently. SIGNIFICANCE: We describe a monitoring protocol characterized by preoperative facial nerve mapping, antidromic stimulation, and recording from multiple muscles. We analyze differences in LSRs in the mentalis and oris muscles and suggest technical points for interpretation.

Long-term stable efficacy of botulinum toxin A in facial movement disorders with no need for increasing dose.

ABSTRACT: Botulinum toxin A is considered an effective treatment for involuntary facial movements. We examined whether treatment efficacy maintained or changed over time with two products, Botox and Dysport, in patients with hemifacial spasm, facial synkinesis and benign essential blepharospasm.We retrospectively investigated 87 consecutive patients (51 women, 36 men) who had undergone treatment for ≥6 years. Long-term effects, as well as side effects of Botox or Dysport local injections were evaluated. The first three treatments were considered the titration period and not taken into account when testing for dose changes.Mean treatment duration was 10 years (range 6-11, SD 1.0), 2441 treatments were administered, 1162 with Botox and 1279 with Dysport, the two brands were interchanged as needed. Good to full improvement was seen in 90% of patients both with both brands. Injection doses and treatment responses were consistent during the study with both drugs. No major side effects were reported, and relatively few minor adverse events were reported, with clear reduction from the titration period (6.1%), to the remainder of the study (3.9%).Botulinum toxin (BTX-A) is a satisfactory long-term treatment without need for dose increase over. Both Botox and Dysport were effective when used interchangeably.

The Five-Year Prospective Study of Quality of Life in Hemifacial Spasm Treated with Abo-Botulinum Toxin A.

This study aimed to determine the long-term quality of life (QoL) in hemifacial spasm (HFS) patients after treating with Abo-botulinum toxin A (Abo-BTX). The study assessed the disease-specific QoL (hemifacial spasm questionnaire 30 items; HFS 30), the involuntary movements (abnormal involuntary movement scale; AIMS), general health QoL (Medical Outcomes 36-Item Short Form Health Survey; SF-36), and Depression (the Center of Epidemiologic Studies-Depression questionnaire; CES-D). A total of 74 HFS patients were enrolled from 2012 to 2017. The disease-specific QoL; involuntary movements; and the general health domain of SF 36 were significantly improved after injections of Abo-BTX A in the first few years (p < 0.04), but significantly decreased at the fifth year of treatment without significant clinical resistance observed (p < 0.001). Only the general health domain of SF 36 showed persistent improvement over five years (p = 0.02). In summary, Abo-BTX A can improved quality of life in the first few years; however only the general health domain of SF-36 showed significant improvement over five years (p = 0.02). No clinical resistance was observed.

Wide distribution of central myelin segment along the facial nerve might explain hemifacial spasm with distal nerve compression.

INTRODUCTION: Many researchers have assumed that neurovascular compression of the facial nerve at the site covered by central myelin sheath causes hemifacial spasm. However, some cases do not correspond to this hypothesis. The aim of this study was to clarify the myelin histology in the facial nerve. MATERIALS AND METHODS: Histological analyses were conducted on 134 facial nerves from 67 cadavers. Three dimensions were measured in these sections: the length from the upper border of the medullopontine sulcus to the boundary between the central and peripheral myelin sheath along the anterior side; the length from the detachment point of the brain stem to the boundary along the posterior side; and the length of the transitional zone (TZ), known as the Obersteiner-Redlich zone. RESULTS: Of the 134 facial nerves, 41 were available for study. The length of the central myelin segment ranged from 4.62 to 12.6 mm (mean 8.06 mm; median 7.98 mm) along the anterior side and from 0.00 to 4.58 mm (mean 1.68 mm; median 1.42 mm) along the posterior side of the facial nerve, and the length of the TZ ranged from 0.00 to 2.76 mm (mean 1.51 mm; median 1.42 mm). CONCLUSIONS: In this study, the length of the central myelin segment in the facial nerve was found to be longer than that previously reported.

Facial Nerve Indentation in Hemifacial Spasm: An Analysis of Factors Contributing to the Formation of and Consequent Effects Associated with Indentation.

BACKGROUND: An indentation, designating a furrowed hole on the facial nerve, has been used in many studies for locating pathophysiology and assessing relevant clinical outcomes after microvascular decompression for hemifacial spasm (HFS). In this study, we sought to elucidate the contributing factors forming indentation on the facial nerve and the consequent effect of having indentation on the clinical course. METHODS: We divided the patients into 2 groups: group A, the patients who had no indentation on the root exit zone of the facial nerve; and group B, the patients who had an indentation. Demographic data, intraoperative findings, and clinical outcomes were analyzed from retrospective review of the medical records. RESULTS: Of the 132 patients, 47.0% had an indentation on the facial nerve. Our statistical analyses showed that the preoperative symptom period, compression location, and compression pattern were associated with the occurrence of the indentation. Also, we showed that HFS reappearance developed more frequently in patients in group B, who needed more time for the resolution of HFS. The final clinical outcome was less influenced by the existence of the indentation, although it was slightly poorer for group B than for group A. CONCLUSIONS: The indentation on the facial nerve was associated with longer duration of symptoms, the presence of compression in the proximal segment of the root exit zone, and loop-type pattern of compression. More patients with indentation experienced the HFS reappearance phenomenon, which lasted longer than in those who had no indentation.

Persistent abnormal muscle response after microvascular decompression for hemifacial spasm.

To explore the causes of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) for hemifacial spasm (HFS) and the clinical outcomes of these patients. MVDs performed in Nanjing Drum Tower Hospital in 2017 were retrospectively studied, and 326 patients with HFS were classified into two groups based on whether AMR disappeared or persisted following MVD. The clinical features, treatment efficacy and postoperative complications were compared between the two groups. 305 patients with disappeared AMR after decompression were classified as Group A. In Group B, the 21 patients exhibited persistent AMR after successful MVD. The preoperative duration of symptoms in Group B was significantly longer than that in Group A (P < 0.001), and no significant difference was identified between the two groups in terms of gender, side, age and offending vessels (P > 0.05). The immediate postoperative cure rate of Group A (88.9%)was significantly higher than that in Group B (28.6%, P < 0.001), furthermore, the two groups were not different in the long-term outcome and the incidence of surgical complications (P > 0.05). The long preoperative duration of HFS patients may account for persistent AMR after successful decompression, and it is more likely for these patients to get delayed cured, the long-term outcomes showed no difference compared to those in patients with disappeared AMR after MVD.

Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm.

OBJECTIVE: To investigate the prognostic and predictive value of intraoperative blink reflex (BR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS: We retrospectively reviewed 41 patients with HFS undergoing MVD with intraoperative BR and lateral spread response (LSR) monitoring. Facial spasm was evaluated for six months postoperatively. RESULTS: The BR resolved in 38 patients and persisted in three after MVD. For patients who exhibited BR resolution, 1-day, 1-month, and 6-month follow-ups revealed that 35 (92.1%), 35 (92.1%), and 38 (100%) patients had spasm resolution, respectively. However, of the three patients with persistent BR, one (33.3%), one (33.3%), and zero (0%) patients exhibited spasm resolution at the three corresponding follow-ups. We found a statistically significant difference in spasm resolution between the persistent and resolved BR groups at six months postoperatively. A comparison between intraoperative BR and LSR monitoring revealed that BR was a better predictor of clinical outcomes. CONCLUSIONS: Intraoperative BR monitoring is a potentially useful tool to help facilitate an adequate decompression and is a reliable prognostic predictor of surgical outcome. SIGNIFICANCE: This study is the first to document the relationship between intraoperative BR monitoring and surgical outcome in patients with HFS.

The Utility of Intraoperative Lateral Spread Recording in Microvascular Decompression for Hemifacial Spasm: A Systematic Review and Meta-Analysis.

BACKGROUND: Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the abnormal lateral spread response (LSR), an evoked response to facial nerve stimulation, has been traditionally used to monitor adequacy of cranial nerve (CN) VII decompression. OBJECTIVE: To assess the utility of LSR monitoring in predicting spasm-free status after MVD postoperatively. METHODS: We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and spasm-free status following the procedure. Sensitivity of LSR, specificity, diagnostic odds ratio, and positive predictive value were calculated. RESULTS: From 148 studies, 26 studies with 7479 patients were ultimately included in this meta-analysis. The final intraoperative LSR status predicted the clinical outcome of MVD with the following specificities and sensitivities: 89% (0.83- 0.93) and 40% (0.30- 0.51) at discharge, 90% (0.84-0.94) and 41% (0.29-0.53) at 3 mo, 89% (0.83-0.93) and 40% (0.30-0.51) at 1 yr. When LSR persisted after MVD, the probability (95% CI) for HFS persistence was 47.8% (0.33-0.63) at discharge, 40.8% (0.23-0.61) at 3 mo, and 24.4% (0.13-0.41) at 1 yr. However, when LSR resolved, the probability for HFS persistence was 7.3% at discharge, 4.2% at 3 mo, and 4.0% at 1 yr. CONCLUSION: Intraoperative LSR monitoring has high specificity but modest sensitivity in predicting the spasm-free status following MVD. Persistence of LSR carries high risk for immediate and long-term facial spasm persistence. Therefore, adequacy of decompression should be thoroughly investigated before closing in cases where intraoperative LSR persists.

Significance of wave I loss of brainstem auditory evoked potentials during microvascular decompression surgery for hemifacial spasm.

OBJECTIVE: We sought to define the significance of wave I loss of brainstem auditory evoked potentials (BAEPs) during microvascular decompression (MVD) surgery for hemifacial spasm. METHODS: Out of 670 patients, 36 showed wave V loss during MVD surgery. These patients were classified into the following two groups based on wave I loss: Total wave loss, including wave I loss, and wave V loss with persistent wave I. We analyzed the differences in postoperative complications between the groups. We also investigated when wave I loss occurred during MVD surgery. RESULTS: Of the 36 patients, 24 (66.7%) exhibited wave I persistence and 12 (33.3%) exhibited total wave loss. The patients who showed total wave loss were significantly more likely to exhibit postoperative hearing loss (p = 0.009). In addition, these patients exhibited a significantly higher frequency of postoperative complications such as dizziness and tinnitus (p = 0.002 and p = 0.031, respectively). Total wave loss occurred more frequently after the decompressive procedure of MVD surgery. CONCLUSIONS: Total wave loss, including wave I loss, was more closely associated with severe postoperative complications. Total wave loss occurred more frequently after the decompressive procedure of MVD surgery. SIGNIFICANCE: These findings suggest the significance of wave I loss of BAEPs.

Prognostic Value of Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm: A Meta-Analysis.

OBJECTIVE: To perform a comprehensive meta-analysis to systematically assess the value of abnormal muscle response (AMR) in predicting the surgical outcome of patients with hemifacial spasm. METHODS: The electronic database PubMed, Embase, Web of Science, and ScienceDirect were searched, and relevant articles were identified up to September 30, 2019. These data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and Fagan plot analysis. RESULTS: The disappearance of AMR during microvascular decompression was associated with a favorable short-term surgical outcome (pooled relative risk [RR], 1.42; 95% confidence interval [CI], 1.24-1.62; pooled RR adjusted for publication bias, 1.30; 95% CI, 1.08-1.57). The corresponding pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.91 (95% CI, 0.88-0.94), 0.34 (95% CI, 0.27-0.42), 1.4 (95% CI, 1.2-1.6), 0.26 (95% CI, 0.17-0.38), and 5 (95% CI, 3-9), respectively. The disappearance of AMR was almost ineffective in predicting the long-term surgical outcome (pooled RR, 1.09; 95% CI, 1.02-1.17; pooled RR adjusted for publication bias, 1.001; 95% CI, 0.92-1.09). The corresponding pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.90 (95% CI, 0.85-0.93), 0.28 (95% CI, 0.20-0.37), 1.2 (95% CI, 1.1-1.4), 0.38 (95% CI, 0.22-0.63), and 3 (95% CI, 2-6), respectively. CONCLUSIONS: The disappearance of AMR during microvascular decompression demonstrates limited prognostic value for a favorable short-term outcome, and does not appear effective in predicting the long-term outcome of patients with hemifacial spasm.

Strengthened thalamoparietal functional connectivity in patients with hemifacial spasm: a cross-sectional resting-state fMRI study.

OBJECTIVE: In spite of the well-known importance of thalamus in hemifacial spasm (HFS), the thalamic resting-state networks in HFS is still rarely mentioned. This study aimed to investigate resting-state functional connectivity (FC) of the thalamus in HFS patients and examine its association with clinical measures. METHODS: 25 HFS patients and 28 matched healthy controls underwent functional MRI at rest. Using the left and right thalamus as seed regions respectively, we compared the thalamic resting-state networks between patient and control groups using two independent sample t-test. RESULTS: Compared with controls, HFS patients exhibited strengthened bilateral thalamus-seeded FC with the parietal cortex. Enhanced FC between right thalamus and left somatosensory association cortex was linked to worse motor disturbance, and the increased right thalamus-right supramarginal gyrus connection were correlated with improvement of affective symptoms. CONCLUSION: Our findings indicate that the right thalamus-left somatosensory association cortex hyperconnectivity may represent the underlying neuroplasticity related to sensorimotor dysfunction. In addition, the upregulated FC between the right thalamus and right supramarginal gyrus in HFS, is part of the thalamo-default mode network pathway involved in emotional adaptation. ADVANCES IN KNOWLEDGE: This study provides new insights on the integrative role of thalamo-parietal connectivity, which participates in differential neural circuitry as a mechanism underlying motor and emotional functions in HFS patients.

Ameliorating Effect of Microvascular Decompression on Patients with Coexistence of Hemifacial Spasm and Glossopharyngeal Neuralgia: A Retrospective Study.

OBJECTIVE: Microvascular decompression (MVD) has been widely accepted for treating hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN); an effective surgical treatment of coexistent HFS and GN still remains to be determined, however. In this paper we discuss the operative strategy of MVD for patients with coexistent HFS and GN. METHODS: This was a retrospective study. All cases of HFS with or without GN at China-Japan Friendship Hospital from January 2014 to June 2016 have been included. All patients underwent MVD and have been followed up for an average of 1.5 years. RESULTS: A total of 5375 cases of HFS were included, wherein 8 cases coexist with GN. Eight patients had same offending vessel(s) compressing the root entry zone of glossopharyngeal nerve and facial nerve. Posterior inferior cerebellar artery was identified as at least 1 of the offending arteries in all 8 patients. After MVD, spasm ceased in all 8 cases, with 7 cases ceasing immediately and 1 within 2 months. Pain disappeared also in all cases, with 7 cases immediately and 1 case after 4 days. No recurrence or complication was observed during the follow-ups. CONCLUSIONS: HFS combined with ipsilateral GN was rare. MVD could be performed to effectively relieve nerve root compression and associated symptoms for coexistent HFS and GN. Sufficient exposure of root entry zones of both nerves and fully decompression of offending blood vessels and exploratory sequences of different nerve roots are critical points for improving operative effect and reducing complications.

Orbicularis Oculi Morphological Alterations in Affected and Nonaffected Sides in Hemifacial Spasm.

BACKGROUND: Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty. METHODS: Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses. RESULTS: When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied. CONCLUSIONS: Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.

An Intraoperative Multibranch Abnormal Muscle Response Monitoring Method During Microvascular Decompression for Hemifacial Spasm.

BACKGROUND: Intraoperative abnormal muscle response (AMR) is widely used as an indicator during microvascular decompression surgery for hemifacial spasm. Usually only 1 muscle is recorded, and not all patients show a response, leaving the surgery somewhat blinded. We propose an improved method to record from multiple muscles innervated by multiple branches of the facial nerve to increase the positive AMR detection rate. METHODS: Retrospective analysis was performed of 1604 patients with hemifacial spasm undergoing microvascular decompression at a single center. All patients were monitored for AMR by stimulating the zygomatic branch of the facial nerve. Only mentalis was recorded in 158 cases (single-branch AMR). Orbicularis oris, frontalis, and mentalis were simultaneously monitored in 148 cases (3-branch AMR), and platysma was further added in the remaining 1298 cases (4-branch AMR). Positive AMR detection rates were compared across the groups. RESULTS: Total positive AMR detection rates significantly increased as more muscles were included in monitoring and were 74.1% for single-branch AMR, 86.5% for 3-branch AMR, and 98.4% for 4-branch AMR. Detection rates from single muscles were not significantly different across the groups. For all available cases, rates were 73.5% from mentalis, 47.2% from frontalis, 64.1% from orbicularis oris, and 40.8% from platysma. CONCLUSIONS: This new multibranch AMR monitoring method can effectively increase the positive detection rate to as high as 98.4%. It is expected to better assist surgery.

Analysis of blink activity and anomalous eyelid movements in patients with hemifacial spasm.

To assess spontaneous blinking and anomalous eyelid movements in patients with hemifacial spasm with an emphasis on interocular differences. Spontaneous eyelid movements were registered bilaterally for 3 min using a high-speed video camera in 28 patients with hemifacial spasm (HFS) who had not been treated with botulinum toxin injections for at least 5 months. The degree of blink conjugacy, maximum velocity, and amplitude of the closing phase of the blinks were determined for the affected and non-affected sides. Out of the 28 subjects, 23 (82%) presented with abnormal nonconjugate spasms that were similar to blinks, and in 17 (61%), high-frequency eyelid twitches were detected between blinks on the affected eye. The rate of nonconjugate blink-like spasms ranged from 0.3 to 24.7 movements/min. With regard for conjugate blinks, there was no significant interocular difference in amplitudes or eyelid closure velocities. The amplitude and velocity were significantly lower for nonconjugate movements than for spontaneous blinks. HFS is a unique condition in which complex patterns of eyelid movements, including both conjugate and nonconjugate movements, are present. Conjugate movements correspond to spontaneous blinking, and the same metrics were observed in affected and non-affected eyes. Nonconjugate movements correspond to anomalous nonconjugate blink-like spasms and high-frequency eyelid twitches in the affected eye, both of which were characterized by lower amplitudes and velocities than were observed in conjugate movements.

Clinical Outcome After Microvascular Decompression According to the Progression Rates of Hemifacial Spasm.

OBJECTIVE: The progression rate for clinical manifestations in hemifacial spasm (HFS) varies; however, little is known about the factors contributing to this. The purpose of this study was to identify independent factors affecting the rate of symptom progression and to evaluate clinical outcomes according to progression rates. METHODS: The study enrolled 1335 patients who underwent microvascular decompression for HFS between July 2004 and January 2015. We assessed detailed history, clinical manifestations, and outcomes. Based on the duration and severity of symptoms, patients were classified into rapidly progressive and slowly progressive groups. We identified predisposing factors affecting the differences between the 2 groups and evaluated the clinical outcome in each group. RESULTS: Of 1335 patients with HFS, 825 (61.8%) were classified as rapidly progressive, and 510 (38.2%) were classified as slowly progressive. In univariable and multivariable analyses, younger age at surgery, older age at symptom onset, and absence of intraoperative facial nerve indentation were significant predisposing factors for rapid progression. The rapidly progressive group had worse outcomes than the slowly progressive group following microvascular decompression. CONCLUSIONS: In this study, patients with rapidly progressive HFS had worse clinical outcomes. Therefore, patients with rapidly progressive symptoms should be warned in advance that the prognosis may be worse after microvascular decompression. This study is also useful to understand the differences in symptom progression rates in HFS in order to inform patients about symptom progression.

More than hemifacial spasm? A case of unilateral facial spasms with systematic review of red flags.

Unilateral facial spasms (UFS) are frequently caused by hemifacial spasm (HFS), a disorder that usually results from vascular loop compression at the root exit zone of the facial nerve. However, UFS can also be a manifestation of other conditions, including brainstem tumours or demyelination, post-Bell's synkinesis, lesions of the facial nerve in the Faloppio canal and the parotid gland, dystonia, epilepsy, psychogenic conditions, tics and hemimasticatory spasm. In this report, we present a case of UFS, not due to HFS, highlighting clinical red flags for an alternative diagnosis. In addition, a systematic review was conducted to provide a comprehensive summary of UFS differential diagnoses with a list of red flags to assist neurologists in the evaluation of patients with UFS.

Can the Jankovic-assessment be used as an alternative to electromyography? A cross-sectional study on facial dystonia patients treated with Botulinum toxin.

PURPOSE: This study aims to quantitatively compare the Jankovic assessment (JA) with electromyography (EMG)-based measures for assessing changes in facial movements in patients with facial dystonia. MATERIALS AND METHODS: Thirteen patients (five males and eight females) affected with different forms of facial dystonia (hemifacial spasm and synkinesis) participated in this study. All patients were treated with Botulinum Toxin (BTX) and evaluated with the JA scale and EMG-based measures, including motor unit potentials (MUP) latency and presence of polyphasic potentials before and after BTX injection. Correlation between the JA scores and the EMG-based measures was calculated. Statistical analysis was performed with the Pearson test. RESULTS: Correlation between the JA scores and the EMG-based measures was found to be statistically significant, both before and after treatment with BTX. CONCLUSION AND RELEVANCE: JA scores significantly correlated with more objective EMG-based measures, suggesting that the JA scale can be used to assess facial movement changes, for example elicited by a treatment such as BTX injection. Thus, in facial dystonia patients, the JA scale may be used for evaluating treatment outcomes as a valid and low-cost alternative to EMG.