Objective: To study demographic and clinical features of  primary and secondary hemifacial spasm and assess their response to botulinum toxin therapy.

Background: Hemifacial spasm (HFS) is a hyperkinetic movement disorder of adults.1 The condition is usually primary, but may be secondary to facial nerve damage and responds well to botulinum toxin therapy.2

Methods: A study of 40 patients of  primary (33) and secondary (7) hemifacial spasm, who attended our botulinum toxin clinic over last 18 months. We collected the data including the demographic profile, clinical features of primary and secondary HFS, severity as measured by Likert scale, etiology, details of magnetic resonance imaging (MRI) of brain and a detailed account of the botulinum toxin injection.

Results: Thirty three out of the 40 patients had primary hemifacial spasm. The mean age at presentation was  48.4±12.6 yrs while mean duration of symptoms was  57.4±39.3 (6-144) months. Onset of spasm in upper face was seen in 31 patients (77.5%). An ipsilateral ear click was found in 17 patients (42.5%). Mild spasms were seen in 18 patients, whereas 12 patients had severe spasm. Severity of spasm was lower in secondary hemifacial spasm patients. Five out of 22 MRI results showed abnormality. Mean dosages of botulinum toxin was 21.86± 4.19 units in primary spasm and 17±4.16 units in secondary spasm (p=.018). The mean duration of  response was 112.6±55.7 days (median:90 days; range: 30-240 days) in primary spasm and 135±63.6 days (median:135 days; range: 90-180 days) in secondary spasm (p=0.29).

Conclusions: Ipsilateral auditory clicks are fairly common in primary and secondary HFS. The patients with secondary hemifacial spasm have a milder intensity of disease and they may have onset from upper part of face. Both primary as well as secondary hemifacial spasm patients respond well to botulinum toxin injection, however the adverse effects are more likely to occur in secondary HFS and they require less dosages of toxin.

References:

1. Evidente VGH, Adler CH. Hemifacial spasm and other craniofacial movement disorders. Mayo Clin Proc 1998;73:67-71.
2. Janetta PJ, Abbasy M, Maroon JC, et al. Etiology and definitive microsurgical treatment of hemifacial spasm. J Neurosurg 1977;47:321–8.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-features-and-response-to-botulinum-toxin-in-primary-and-secondary-hemifacial-spasm/