الفهرس 
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Abstract
Hemi-facial spasm (HFS) is a movement disorder of the seventh cranial nerve which
The aim of the work is evaluate different modalities in treatment of hemi-facial spasm.
This study was conducted on 30 patients presenting with hemi-facial spasm. We included patients with unilateral involuntary facial muscle contractions affecting one or more muscle groups innervated by the facial nerve. We excluded patients with myokymia (focal undulating, muscle contraction), tardive dyskinesia, and other forms of facial or oromandibular dystonic movements.
All patients were subjected to proper pre-treatment assessment including; proper history taking, clinical examination, Proper radiological investigations when needed. They were divided into three groups according to treatment modalities group A received oral medications (gabapentine or levetiracetam), group B received Botox injection and group C undergone Micro-vascular decompression. Patients returned to follow up in 1and 3 months. Outcome of treatment were compared among different groups.
The mean of age at onset was 51.8 among all patients (range 40-65 years). The female to male ratio was 2.75:1 in all groups. Orbicularis occuli was the most common muscle affected. The mean duration of the condition were 37.3 month in group A, 34.9 month in group B and 46 month in group C respectively. The overall mean of duration of the condition was 38.8 month. The left side was the most common side affected in all groups. The most common associated morbid condition was hypertension followed by diabetes.
Among group A, six patients received carbamazepine in dose ranges (400-1000 mg), three patients received carbamazepine and baclofen combination and three patients received previous botox injections in previous treatment modalities. Six patients received Gabapentin in doses (800-1200) and five patients received levetiracetam in doses (1500-2000) in current study. Follow up period ranged from 3 months to 24 months. Two to three weeks lapsed to reach therapeutic response. One patient showed excellent response to treatment (Gabapentin 1200 mg), three patients had good response, four patients had fair response, while three patients had poor response to treatment (one used levetracetam- two used gabapentin).
Overall success rate is 69.1%. Five patients had dizziness that was temporary. Two patients suffered from somnolence, while one patient suffered from confusion that necessitated reduction of the dose (Gabapentin). Overall incidence was 63.6%.
Among group B patients, six patients had received carbamazepine in doses (800-1200), four patients had drug combination (carbamazepine - baclofen) and only two patients received previous botox injections in previous treatment modalities. All patients received botox injections that were tailored according muscles affected where orbicularis oculi received combination of pretarsal and pre-septal injection.
Total dose range (20-50 U) with a mean 36.7 U. Upper face received 20 U, lower face received also 20 units while platysma received only 10 units in current study. There was delay in onset of the effect ranges from 4 to 12 days with a mean 7 days. The botox effect last from 15 to 24 weeks (mean 20.5). Four patient enjoyed excellent response. Another four patients had good response, while three patients had fair response. Only one patient had poor response. Overall success rate was 83.3%. Two patients had ptosis that last less than month. One patient suffered from lid swelling that was treated with clod compresses. Only one patient had mouth dropping which last two months to resolve. Overall incidence was 33.3%.
Among group C patients, all patients received drug combination (carbamazepine –baclofen). No patient had botox injection or previous Micro-vascular decompression. AICA was found compressing the nerve in four patients. PICA was the offending vessel in three patients. Five cases had excellent outcome and two cases had good outcome. Overall success rate is 100%. There was no recurrence of spasm during flow up period which ranges from sex months to 1 year. Only one case showed delay response to surgery (4 days) with an incidence 14%. We had one case with CSF leak that required repeated lumbar puncture with antibiotic coverage. Two cases showed temporary decrease in hearing that returned to preoperative status within one month. Overall incidence was 42.8%.
from the study, we concluded that Micro-vascular decompression offers the best chance to permanent cure with low complication rate. New antiepileptics (levetiracetam,gabapentin) provide a safe relative effective therapy for patients refusing surgical option or Botox injection. Botox is an attractive local therapy with reversible complications but with non-sustainable effect