Spasm, hemifacial

Botulinum neurotoxins are widely used as therapeutic agents to cause reduction or paralysis of skeletal muscle contraction. They are used to treat cervical dystonia, which causes regional involuntary muscle spasms often associated with pain. Moreover, they are used in strabism, blepharospasm, hemifacial spasm, and... 

Botulinum toxin is the treatment of choice for focal dystonias such as torticollis and writer s cramp and for hemifacial spasm, and may complement the management of spasticity. 

Hemifacial spasm/postfacial nerve palsy synkinesis... 

Unlike blepharospasm, the origins of hemifacial spasm are much better understood. Hemifecial spasm may occasionally be familial. In most instances, however, the spasm results from microvascular compression or irritation of the facial nerve by an aberrant artery of abnormal vasculature in the posterior fossa or from a cerebellopontine tumor. 

Figure 22-17 Sites of botulinum toxin injection in patient with hemifacial spasm.

Adverse events in patients who receive botulinum toxin injections for hemifecial spasm are virtually identical to those that occur in treatment of BEB. However, diplopia and lower facial weakness are more common in patients with hemifacial spasm. 

Involuntary muscle spasm blepharospasm, hemifacial spasm, spasmodic torticollis, and indeed the spasm of chronic anal fissure, are treated with botulinum toxin. This irreversibly blocks release of acetylcholine from cholinergic nerve endings and is injected locally. Its effect lasts about 3 months. Botulinum toxin is at least partially effective in up to 90% of patients with these conditions. Mild dysphagia occurs in 30% of patients receiving injections into their neck for torticoUis due to spread of the toxin in to the pharyngeal muscles. 

Indications Blepharospasm, hemifacial spasm, spasmodic torticollis, sialorrhea, hyperhidrosis, strabismus, oromandibular dystonia, cervical dystonia, spasmodic dysphonia. Cosmetic application for wrinkles... 

Food-borne botulism results from the ingestion of food contaminated with preformed toxins or toxin-producing spores from C. bo-tulinum. C. botulinum poisoning is relatively rare only 110 cases are reported per year in the United States. Botulism is almost always associated with improper preparation or storage of food. Seven distinct toxins (A to G) have been described. The toxins, which are produced by the bacteria and released on lysis, are the most potent biologic or chemical toxins known to humans. The toxin prevents the release of acetylcholine at the peripheral cholinergic nerve terminal. Toxin activity has prompted the use of minute locally injected doses to treat select spastic disorders, such as blepharospasm, hemifacial spasm, and certain dystonias. ... 

Muscle Spasms Hemifacial spasm Facial synkinesis Masticatory spasm... 

B. A (Botox , Dysport ) has an Mr of ca. 90(XX) and is used in extremely small doses in ophthalmology to treat idiopathic blepharospasm (squinting) and other spasms such as hemifacial spasm, facial paralysis, TMJ (temporomandibular joint disorder), writer s cramp, extreme sweating, etc.. Recent clinical data show, that B. is effective in the treatment of essential hand tremor and upper limb spasticity after a stroke, as well as in certain cases of headache/migraine. lit J. Neurology, Neurosurgery and Psychiatry 64, 751 (1998). 

A total of 182 patients (73 male, 109 female) with various facial region disorders were retrospectively studied using botulinum toxin injection for the treatment of facial region disorders [19 j. Improvement in symptoms was marked and good in subjects treated for blepharospasm, hemifacial spasm, facial s5mkinesis and Meige syndrome, and moderate for oromandibular dystonia and hypersalivation. Ptosis was the most common side effect. 

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