Abstract
Objective
We studied blink reflex (BR) and BR excitability recovery (BRER) in patients with hemifacial spasm (HFS) exhibiting different abnormal discharge patterns. We hypothesized that patients with groups of clonic or tonic burst activities appear later in the disease course and may have more excitability of the BR circuit at the brainstem compared to patients with isolated twitchings, which occur earlier.
Methods
We included 124 patients with botulinum toxin-naive HFS (mean age 50.6 ± 13.3 years) and 40 healthy subjects. We performed surface polymyography on facial muscles in patients and classified them according to the abnormal discharge pattern: isolated discharges, grouped bursts forming random sequences, tonic spasms, and a combination of these activities. Then, we recorded BR and BRER at 200, 600, and 1000 ms interstimulus intervals. We compared disease duration, R1 and R2 latencies, R2 area-under-the-curve (AUC), and BRER% (i) between healthy subjects and patients and (ii) among groups of patients with different abnormal discharge patterns.
Results
There were isolated discharges in 28 patients, grouped bursts forming random sequences in 42, and continuous muscle activity with tonic spasms in one. The remaining patients had combinations. Mean R1 and R2 latencies were significantly longer, and mean R2 AUC was significantly higher on the symptomatic side of patients compared to healthy subjects. The mean BRER was enhanced on both sides in patients than in healthy subjects (p < 0.001). However, it was similar among patient groups with different abnormal discharge patterns (p > 0.05). The mean disease duration in patients with isolated discharges was shorter (3.3 ± 2.0 years) than those with grouped bursts or tonic spasms (p = 0.002; Kruskal–Wallis test).
Conclusion
Our study observed that excitability at the brainstem was similar in HFS patients with different abnormal discharge patterns, suggesting that the difference in discharge patterns in HFS may be due to a reason other than the difference in BR excitability.
Similar content being viewed by others
Data availability
The data that support the findings of this study are available on request from the corresponding author.
References
Ehni G, Woltman HW (1945) Hemifacial spasm: review of one hundred and six cases. Arch NeurPsych 53:205–211. https://doi.org/10.1001/archneurpsyc.1945.02300030042006
Williams HL, Lambert EH, Woltman HW (1952) The problem of synkinesis and contracture in cases of hemifacial spasm and Bell’s palsy. Ann Otol Rhinol Laryngol 61:850–872. https://doi.org/10.1177/000348945206100321
Nielsen VK (1985) Electrophysiology of the facial nerve in hemifacial spasm: ectopic/ephaptic excitation. Muscle Nerve 8:545–555. https://doi.org/10.1002/mus.880080702
Valls-Solé J (2013) Facial nerve palsy and hemifacial spasm. Handb Clin Neurol 115:367–380. https://doi.org/10.1016/B978-0-444-52902-2.00020-5
Valls-Solé J, Tolosa ES (1989) Blink reflex excitability cycle in hemifacial spasm. Neurology 39:1061–1066. https://doi.org/10.1212/wnl.39.8.1061
Oge AE, Yayla V, Demir GA, Eraksoy M (2005) Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia. Clin Neurophysiol 116:1542–1554. https://doi.org/10.1016/j.clinph.2005.02.021
Kimura J (1973) Disorder of interneurons in parkinsonism: the orbicularis oculi reflex to paired stimuli. Brain 96:87–96. https://doi.org/10.1093/brain/96.1.87
Valls-Solé J (2012) Assessment of excitability in brainstem circuits mediating the blink reflex and the startle reaction. Clin Neurophysiol 123:13–20. https://doi.org/10.1016/j.clinph.2011.04.029
Basso MA, Evinger C (1996) An explanation for reflex blink hyperexcitability in Parkinson’s disease. II. Nucleus raphe magnus. J Neurosci 16:7318–7330. https://doi.org/10.1523/JNEUROSCI.16-22-07318.1996
Basso MA, Powers AS, Evinger C (1996) An explanation for reflex blink hyperexcitability in Parkinson’s disease. I. Superior colliculus. J Neurosci 16:7308–7317. https://doi.org/10.1523/JNEUROSCI.16-22-07308.1996
Eekhof JL, Aramideh M, Bour LJ, Hilgevoord AA, Speelman HD, Ongerboer de Visser BW (1996) Blink reflex recovery curves in blepharospasm, torticollis spasmodica, and hemifacial spasm. Muscle Nerve 19:10–15. https://doi.org/10.1002/(SICI)1097-4598(199601)19:1%3c10::AID-MUS2%3e3.0.CO;2-B
Valls-Solé J (2000) Neurophysiological characterization of parkinsonian syndromes. Neurophysiol Clin 30:352–367. https://doi.org/10.1016/s0987-7053(00)00236-7
Cabib C, Llufriu S, Martinez-Heras E, Saiz A, Valls-Solé J (2014) Abnormal control of orbicularis oculi reflex excitability in multiple sclerosis. PLoS ONE 9:e103897. https://doi.org/10.1371/journal.pone.0103897
Sciacca G, Mostile G, Disilvestro I, Donzuso G, Manna R, Portaro G, Rascunà C, Salomone S, Drago F, Nicoletti A, Zappia M (2020) Asymmetry index of blink reflex recovery cycle differentiates Parkinson’s disease from atypical parkinsonian syndromes. J Neurol 267:1859–1863. https://doi.org/10.1007/s00415-020-09900-6
Donzuso G, Sciacca G, Luca A, Cicero CE, Mostile G, Nicoletti A, Zappia M (2022) Corticobasal syndrome and Parkinson’s disease at the beginning: asymmetrical patterns of MRI and blink reflex for early diagnosis. J Neural Transm (Vienna) 129:1427–1433. https://doi.org/10.1007/s00702-022-02557-7
Ferguson JH (1978) Hemifacial spasm and the facial nucleus. Ann Neural 4:97–103. https://doi.org/10.1002/ana.410040202
Kofler M, Kumru H, Schaller J, Saltuari L (2013) Blink reflex prepulse inhibition and excitability recovery: influence of age and sex. Clin Neurophysiol 124:126–135. https://doi.org/10.1016/j.clinph.2012.07.001
Schoeck AP, Mellion ML, Gilchrist JM, Christian FV (2007) Safety of nerve conduction studies in patients with implanted cardiac devices. Muscle Nerve 35:521–524. https://doi.org/10.1002/mus.20690. (PMID: 17094099)
Cronin EM, Gray J, Abi-Saleh B, Wilkoff BL, Levin KH (2013) Safety of repetitive nerve stimulation in patients with cardiac implantable electronic devices. Muscle Nerve 47:840–844. https://doi.org/10.1002/mus.23707
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors report no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gündüz, A., Aliş, C. & Kızıltan, M.E. Blink reflex excitability in patients with Hemifacial spasm exhibiting different abnormal discharge patterns: from early isolated discharges to later grouped bursts or tonic spasms. Acta Neurol Belg 124, 495–501 (2024). https://doi.org/10.1007/s13760-023-02445-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-023-02445-1