The Observation Of Clinical And Electrophysiological Tests İn The Cases with Hemifacial Spasm Under The Treatment Of Botulinum Toxin


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2018

Thesis Language: Turkish

Student: ÖZLEM KURTKAYA KOÇAK

Supervisor: HATİCE AYŞE BORA

Abstract:

In our study, we aimed to investigate the clinical and electrophysiological effects of BoNT in 16 idiopathic HFS cases. For this purpose, we evaluated the HFS cases with blink reflex, orbicularis oculi CMAP and repetitive nerve stimulation test, before the BoNT injection and at the first week, at the first and fourth months of post treatment period. We also calculated the HFS severity and HFS-7 quality of life scale scores at each visit. As a result of our study, there was significant decrease in HFS severity and HFS-7 quality of life scale scores at all follow-up periods after BoNT injection. CMAP amplitudes of the orbicularis oculi muscle were significantly decrease after BoNT injection and decrement responses were observed in low frequency repetitive nerve stimulation test on the affected side. The latencies of blink reflexes (R1, İR2, KR2) of the affected orbicularis oculi muscle and R1 synkinetic responses of the orbicularis oris muscle were significantly increased after BoNT injection. There was also a significant decrease in amplitude and area values of orbicularis oris muscle synkinetic responses. All these findings were the most prominent at the 1st month after BoNT injection and still continued at the 4th month. In our study, a significant correlation was found between HFS severity and 118 HFS-7 quality of life scale and orbicularis oris synkinetic response amplitude and area changes. In conclusion, our study shows that BoNT has an effect on the brainstem circuits by suppressing the excitability of the facial nerve motor nucleus via the trigeminal afferent system as well as the neuromuscular junction effects. In addition, the orbitalis oris synkinetic response amplitude and area value correlated with HFS severity suggest that blink reflex can be used electrophysiologically to evaluate disease severity.