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Hemifacial spasm
The document discusses hemifacial spasm, a condition characterized by involuntary contractions of facial muscles due to abnormal firing of facial nerve motor units. It covers the anatomy, etiology, pathophysiology, clinical features, differential diagnosis, and treatment options, including the use of botulinum toxin and surgical interventions. The document also highlights various cases and treatment pearls to optimize patient outcomes.
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Hemifacial spasm
- 1. Amr Hasan, M.D. Lecturerof Neurology - Cairo University CairoNeuro 2014 Botulinum toxin in hemifacial spasm: A real “Face Off”
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- 3. Agenda Hemifacial spasm 3 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 4. Agenda Hemifacial spasm 4 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 5. Anatomy of facialmuscles 5
- 6. Anatomy of facialmuscles 6
- 7. Anatomy of facialmuscles 7
- 8. Anatomy of facialmuscles 8
- 9. Anatomy of facialmuscles 9
- 10. Anatomy of facialmuscles 10
- 11. 11 Anatomy of facialmuscles
- 12. Anatomy of facialmuscles 12
- 13. Anatomy of facialmuscles 13
- 14. Anatomy of facialmuscles (circumorbital and palpebral muscles) 14
- 15. Anatomy of facialmuscles (circumorbital and palpebral muscles) 15
- 16. 16 Anatomy of facialmuscles (circumorbital and palpebral muscles)
- 17. 17 Anatomy of facialmuscles (Nasal Muscles)
- 18. 18 Anatomy of facialmuscles (Nasal Muscles)
- 19. 19 Anatomy of facialmuscles (Nasal Muscles)
- 20. 20 Anatomy of facialmuscles (Buccolabial muscles)
- 21. 21 Anatomy of facialmuscles (Buccolabial muscles)
- 22. 22 Anatomy of facialmuscles (Buccolabial muscles)
- 23. 23 Anatomy of facialmuscles (Buccolabial muscles)
- 24. 24 Anatomy of facialmuscles (Buccolabial muscles)
- 25. 25 Anatomy of facialmuscles (Buccolabial muscles)
- 26. 26 Anatomy of facialmuscles
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- 28. Agenda Hemifacial spasm 28 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 29. Agenda Hemifacial spasm 29 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 30. Hemifacial Spasm Characterized by: 30 •Paroxysmal, involuntary clonic and tonic synchronous contraction of the muscles innervated by the facial nerve on one side. • The spasms are due to brief burst of normal motor units firing at high frequency.
- 31. Agenda Hemifacial spasm 31 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 32. Agenda Hemifacial spasm 32 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 33. Hemifacial Spasm Causes: 33 • Vascularcompression of the facial nerve by a dolichoectatic (a distorted, dilated, and elongated) vertebral artery or tortuous AICA. • Facial nerve compression by a mass, brainstem lesions such as stroke or multiple sclerosis plaques.
- 34. Hemifacial Spasm Causes: 34 • Secondarycauses such as trauma or Bell palsy. • Familial • Idiopathic
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- 36. Agenda Hemifacial spasm 36 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 37. Agenda Hemifacial spasm 37 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 38. Hemifacial spasm 38 transmission, whichis electrical activity crossing from onephapticE synapse.demyelinated neuron to another resulting in a false root end zonefacial nerveat theaxonsnvolves abnormal activity ofI demyelination.secondary to compressive damage/ facial nerveor "Kindling theory" involves increased excitability of the nucleus due to feedback from a damaged facial nerve.
- 39. Agenda Hemifacial spasm 39 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 40. Agenda Hemifacial spasm 40 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 41. Hemifacial spasm 41 • Unilateral(rarely bilateral) spasm involving half of the facial muscles, typically lasting several minutes at a time. • Affects women more than men. • Onset fifth and sixth decade. • Persists during sleep.
- 42. Hemifacial spasm 42 • Painless,no sensory loss. • Involves entire side of face. • HS most often begins insidiously in the orbicularis oculi muscle.
- 43. Hemifacial spasm 43 • Contractionsgradually spread to other muscles of the face including the platysma
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- 45. Hemifacial spasm Differential Dx: 45 •Blepharospasm • Meige’s syndrome (not to be confused with Meigs' syndrome,the triad of ascites,pleural effusion and benign ovarian tumor) • Tourette’s syndrome (multiple compulsive muscle spasms associated with utterances of bizarre sounds or vile words). • Trigeminal Neuralgia (acute episodes of pain in the distribution of the V CN) • Eyelid Myokymia (eyelid twitches; caffeine & stress) • Tardive Dyskinesia (Orofacial dyskinesia, associated with dystonic movements of the trunk and limbs, from long-term antipsychotic drug use) • Eyelid apraxia
- 46. Hemifacial spasm Blepharospasm: 46 • Onset:usually in adult life (sixth & seventh decade) • 3:1 female predominance • Always Bilateral, episodic, involuntary contractions of the orbicularis oculi (therefore, may not involve other facial muscles). • Disappears during sleep. • Possible association with involuntary spasm of the lower facial musculature (orofacial dyskinesia or Meige’s Syndrome).
- 47. Hemifacial spasm Blepharospasm: 47 • Etiology: •Adults: usually idiopathic (“essential blepharospasm”) related to dysfunction of the basal ganglia and limbic system. • May occur in patients with: Parkinson’s disease Progressive supranuclear palsy Huntington’s disease Multiple Sclerosis Brainstem stroke
- 48. Agenda Hemifacial spasm 48 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 49. Agenda Hemifacial spasm 49 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 50. Hemifacial spasm 50 • WorkUp – MRI of cerebellopontine angle to R/O tumor
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- 52. Agenda Hemifacial spasm 52 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 53. Agenda Hemifacial spasm 53 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 54. Hemifacial spasm Treatment 54 • Pharmachologic:Carbomazepine, Baclofen, Clonazepam, Neurontin • Botulinum toxin • Surgery: Janetta procedure=posterior fossa craniotomy with insertion of inert material b/w vascular loop and VII nerve (to decrompress the nerve).
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- 61. Sites of injectionfor BEB 61
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- 63. • Ptosis (7-11%) •Lagophthalmos (5-12%) • Symptomatic dry eyes • Diplopia (<1%) • Ecchymosis • Lower facial weakness Potential adverse effect 63 • Facial assymetry.
- 64. Agenda Hemifacial spasm 64 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
- 65. Agenda Hemifacial spasm 65 • Anatomyof facial muscles • Definition • Aetiology • Pathophysiology . • Investigations • Clinical features and differential diagnosis. • Botulium toxin in hemifacial spasm • Video presenations
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- 67. Case 1 • 32ys old male. • Unremarkable medical history. • 3 years ago started to develop Rt HFS • Increasing in frequency up to being continous all over the day • MRI Brain : Normal 67
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- 70. Case 2 • 16ys old girl. • Student • 4 years ago, she had Bell’s palsy • Afterwhich, she started to develop Rt HFS • Embarrasing and disfiguring 70
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- 73. Case 3 • 42ys old Yemenese man. • Employee • 2 years ago, he started to develop bilateral facial dyskinsia (ocular, facial, orobuccal) • Khat 73
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- 76. Pearls 76 • Up to50 units at one treatment. • Injection should not be made inferior to the nasolabial fold! Injections here cause lip droop that in turns leads to very annoying lip biting by the patient. • Avoid injecting the mid portion of the upper lid so as to avoid paralyzing the levator palpebri and causing ptosis. • Avoid orbicularis oris • Smaller dose for zygomaticus major • Lower dose if secondary to facial palsy
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