الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hemifacial spasm is a neuromuscular disorder characterized by frequent, involuntary muscle contractions (spasms) of the muscles innervated by the ipsilateral facial nerve.
Patients with HFS usually present at between 40 and 50 years of age, they frequently complain of involuntary eye closure, which interferes with vision and causes social embarrassment.
The initial site of onset was the orbicularis oculi muscle, over months to years, the spasms spread gradually to other muscles innervated by the ipsilateral facial nerve in a
synchronous manner. Bilateral HFS is occasionally reported, when HFS is bilateral, the second side becomes
involved after a long interval and the movements on each side are usually asynchronous. With the advent of advanced imaging (MRI and MRA) and improved surgical techniques, vascular compression of the facial nerve by an ectactic vessel has been demonstrated to be the most common underlying aetiology of HFS. Treatment of HFS: - The efficacy of oral medications is often mild and transient.Carbamazepine, anticholinergics, and clonazepam, all have all been studied in HFS,
However, adverse effect of all these medications is common, particularly when high doses are used.
- Botulinum toxin injection, good to excellent improvement was reported in 75% to 100% of patients with HFS, and the mean duration of action was about 3 - 6 months. Adverse effects included dry eyes, ptosis, eyelid and facial weakness, ptosis, diplopia, and
excessive tearing, however, these effects were transient, and no serious systemic effects have been reported. In experienced hands, adjustment of dosage, and site of injection may
reduce some of these adverse effects in subsequent treatment. Repeated injections are generally well tolerated, and benefit is maintained over the years of therapy. Many
neurologists currently regard botulinum toxin as the treatment of choice for HFS. - Micro vascular decompression (MVP) of the facial nerve at the cerebellopontine angle,
the most common surgical procedure carried out today, results in markedly improved HFS in the majority of patients, however, a recurrence rate of up to 20% with common complications have been reported. With the advent of BTX treatment, which has been
shown to be safe and effective, potential complications associated with MVP may be unacceptable to some patients
Methods:
Forty patients diagnosed as having hemifacial spasm divided into 2groups. First group will receive botox injection, Second group will receive medical treatment in the form of
carbamazepine and following the 2groups for 3 months in 3 sessions (first session before treatment, second session after 6 weeks of treatment and third session after 12 weeks of
treatment). Data about age, sex, side, start of illness, comorbid medical disease and previous medical
treatment intake were obtained and assessed. Patients were asked information regarding severity of the spasm and the response of the
patients to both treatments in the three sessions using two different scales. First one is
HFS-36 scale with 36 questions, each question take 0- 4 points according to the severity. Second one is HFS-7 scale with 7 questions with the same previous score Total score for all questions in HFS-36, HFS-7 scales was done for each session in both groups. Follow
up of improvement and response in both groups was assessed by how much decrease in points indicating severity patients get it in the second, third session decrease in comparison to baseline of points patients got in the first session. Other information regarding occurrence of side effects of both treatment was obtained
after each session. Data regarding start of effect, peak effect and duration of effect of
both treatments were obtained and assessed. Results:
As regarding age, sex, side, start of illness, comorbid medical disease and previous medical treatment intake no significant difference between two groups could be detected
(p = .80, p = .39).
As regarding start of effect, peak effect and duration of effect of both treatments no significant difference between two groups could be detected (P = .03 \ .11 \ .06). As regarding patients response to both treatment using HFS-36 and HFS-7 scales
(measuring severity of HFS), patients who had received botox injection showed very good improvement with very highly significant difference (P<0.0001, P<0.0001) in session two and three in comparison to first session (before treatment), while in patients
who had received carbamazepine showed good improvement with significant difference (P< 0.01, P< 0.01) in comparison to first session.
By comparing the results of sessions two and three (after 6 and 12 weeks of treatment) in both groups using the two scales, patients receiving botox injection showed very good
improvement and very highly significant difference (p < 0.0001) in comparison to second group patients whom show only good improvement. No side effects could be detected in patients receiving botulinum toxin injection while in
patients receiving carbamazepine side effects occurred in 75% of patients (15 patients)with 11 patients (55%) stopped to take it after 2 weeks.