Objective: The purpose of this study is to evaluate the effect of various anti-epileptic drugs(AED) in the medical management of HFS in patients who cannot afford Botulinum toxin and are not suitable candidates for surgery.

Background: Hemifacial spasm(HFS) is defined as unilateral, involuntary, irregular clonic or tonic movement of facial innervated muscles. Most of the cases are idiopathic or primary and treatment options are Botulinum toxin, decompressive surgery or medical management. However, Botulinum toxin is expensive and out of reach for many patients in the developing countries and in the absence of any definite vascular compression surgery is not advisable. Data and articles regarding medical management are scarce and various drugs have been tried for the same.

Method: We reviewed the clinical features and response to different drugs in 45 HFS patients over last one year evaluated at our Neurology Clinic who could not afford botulinum toxin or had refused surgery.

Results: HFS was seen more in females (84%), the mean age of onset was 38  ± 12.2 years and the mean duration of symptoms was 5.6  ± 3.5 years. The left side was affected in 67% of the cases and no patient had bilateral HFS. Only 5 (11%) patients had history of prior bell’s palsy. Vascular compression was evident in 8 (18% )of the patients. Carbamazepine, Oxcarbazepine, Clonazepam, and Lamotrigine were the drugs tried either alone or in combination. Carbamazepine alone (22%) or with clonazepam (33%) was the most common combination used followed by Oxcarbazepine with clonazepam (22%). The maximum tolerated dosage of Carbamazepine was 800 mg/day; the limiting side-effects being giddiness and sedation. 3 patients developed skin rashes with Carbamazepine which was not life-threatening. Lamotrigine was used in 5 patients without any side-effects. 8 patients (17%) reported significant improvement in their symptoms and 14 patients (31%)reported partial improvement.

Conclusion: The most effective AED for HFS was Carbamazepine alone followed by Oxcarbazepine with clonazepam and Lamotrigine alone. Clonazepam and Oxcarbazepine alone were not beneficial and Lamotrigine was an alternative for patients not tolerating Carbazepine. Controlled trials are needed in a larger number to establish the findings of this study.

References: 1. Abbruzzese G, Berardelli A, Defazio G. Hemifacial spasm. Handb Clin Neurol. 2011. 100:675-80. [Medline]. 2. Yaltho TC, Jankovic J. The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord. 2011 Aug 1. 26(9):1582-92. [Medline]. 3. Elston JS. The management of blepharospasm and hemifacial spasm. J Neurol. 1992 Jan. 239(1):5-8. [Medline].

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MDS Abstracts - https://www.mdsabstracts.org/abstract/medical-management-of-primary-hemifacial-spasm/