Effectivity of Dysport in patients with blepharospasm and hemifacial spasm who experienced failure with Botox.
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BACKGROUND: Long-term therapy with botulinum toxin is sometimes associated with therapy failure following repeated injections of the neurotoxin, presumably due to specific antibody production. Primary therapy failure with botulinum toxin is less common and poorly understood. OBJECTIVES: To examine the effectiveness of the botulinum neurotoxin Dysport in patients with blepharospasm and hemifacial spasm after primary or secondary failure with Botox treatments. METHODS: In this case series study, eight patients with blepharospasm and hemifacial spasm who experienced primary or secondary therapy failure with Botox were treated with Dysport. In order to render an equivalent Dysport dose, a conversion ratio of 1:3 to 1:4 Botox/Dysport was used. RESULTS: Two patients, one with blepharospasm and the other with hemifacial spasm, who showed primary therapeutic failure with Botox showed good response to Dysport treatments. One patient with tardive blepharospasm did not respond to either drug. Two patients with blepharospasm and three patients with hemifacial spasm who experienced Botox secondary therapy failure responded well to Dysport treatments. CONCLUSIONS: Botox and Dysport are both serotype A botulinum toxins but carry different characteristics of biological activity. These differences possibly account for the favorable therapeutic response to Dysport in patients with hemifacial spasm or blepharospasm following failure with Botox treatments. (+info)
Retroclival arachnoid cyst with hemifacial spasm.
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Arachnoid cysts are rare lesions occurring anywhere in the cerebrospinal axis. The sylvian fissure remains the most favoured site for their occurrence, followed by cerebellopontine angle, suprasellar, and quadrigeminal cisterns. Retroclival arachnoid cysts are very rare. We report a retroclival arachnoid cyst with bilateral cerebellopontine angle extensions with hemifacial spasm in a 26-year-old woman. The patient underwent surgery and her hemifacial spasm improved. (+info)
Executive functioning in patients with blepharospasm in comparison with patients with hemifacial spasm.
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Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve associated with configuration variation of the facial and vestibulocochlear nerve complex.
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It is generally accepted that hemifacial spasm (HFS) is caused by vascular compression at the root exit zone (REZ) of the facial nerve. We saw an HFS patient caused by vascular compression of the distal portion of the facial nerve associated with configuration variation of the facial-vestibulocochlear nerve complex. A 50-year-old female with left HFS was admitted to our hospital. Preoperative magnetic resonance image demonstrated no offending artery around the facial nerve at the nerve's REZ. Microvascular decompression of the left seventh cranial nerve was performed via a lateral suboccipital infrafloccular approach. The facial nerve arose more than 5 mm away from the vestibulocochlear nerve in the brain stem and both traveled apart toward the internal acoustic meatus in the cerebello-pontine cistern. No offending vessel was observed near the REZ of the facial nerve. The abnormal muscle responses of the mentalis muscle disappeared when the AICA was separated from the distal portion of the facial nerve. The patient was completely free of the HFS following surgery. The facial nerve arising away from the vestibulocochlear nerve in the brain stem is rare. It might influence the cause of HFS with compression of the distal portions of the seventh cranial nerve. (+info)
Three-dimensional MR volumetric analysis of the posterior fossa CSF space in hemifacial spasm.
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