Objective: To evaluate the therapeutic and preventive effect of OnabotulinumtoxinA (BoNT/A) in the treatment of hemifacial spasm, bruxism, and trigeminal neuralgia post Ramsay Hunt Syndrome.

Background: Ramsay Hunt Syndrome (RHS) type II, is a cranial polyneuropathy, refers to the association of unilateral peripheral facial nerve palsy and herpes zoster infection of the ear, is caused by re-activation of the varicella-zoster virus within the geniculate ganglion. There are few studies that report the beneficial effect of BoNT/A injections for the management of the exceptionally infrequent association of ipsilateral hemifacial spasm, bruxism and post-herpetic trigeminal neuralgia as chronic neurological complications post RHS.

Methods: We conducted open administration of BoNT/A and follow-up for 7 years in patients with chronic neurological complications post RHS. BoNT/A was injected either intradermal or submucosal into the painful areas and their trigger zones of trigeminal nerve. Changes in movement disorder and neuropathic pain were evaluated. Patients reported their medication use (analgesics and preventative treatment) and baseline measures were determined before and after (30, 90, 180 and 270 days) BoNT/A injections. Assessment by medical observation, video recordings and by patients’ subjective ranting and Visual Analog Scale (VAS).

Results: From 321 patients with hemifacial spasm, only 4 fulfilled inclusion criteria. We report 4 immunocompetent adults with concomitant unilateral hemifacial spasm and trigeminal neuralgia post RHS type II. One of them also had ipsilateral bruxism. Three patients had recurrent episodes of herpes zoster oticus. After BoNT/A treatment, patients had a significant reduction in pain and movement disorder during 3-7 months, without side effects and all patient stopped analgesics and neuromodulators during maximal therapeutic effect of BoNT/A (Table 1, Table 2).

Conclusions: Our findings suggest that BoNT/A injections in trigeminal nerve trigger points are an effective and safe therapy for some chronic complications post RHS type II, such as hemifacial spasm, bruxism and trigeminal neuralgia, even in the presence of ipsilateral facial weakness.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/therapeutic-effect-of-onabotulinumtoxina-bonta-in-hemifacial-spasm-and-trigeminal-neuralgia-post-ramsay-hunt-syndrome-type-ii/