Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses

Mami Ishikawa M.D. 1 , Takayuki Ohira M.D., Ph.D. 1 , Jun Namiki M.D., Ph.D. 1 , Masato Kobayashi M.D. 1 , Moriichiro Takase M.D. 1 , Takeshi Kawase M.D., Ph.D. 1 , and Shigeo Toya M.D., Ph.D. 1
View More View Less
  • 1 Departments of Neurosurgery and Clinical Neurophysiology, School of Medicine, Keio University, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve—evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 ± 1.7 (mean ± standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely, F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Mami Ishikawa, M.D., Department of Neurosurgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan.
  • 1.

    Ahiron A, & Sarova-Pinhas I: The value of F wave in Bell's palsy—a study of F wave response in the facial muscles. Electromyogr Clin Neurophysiol 24:99106, 1984 Ahiron A, Sarova-Pinhas I: The value of F wave in Bell's palsy—a study of F wave response in the facial muscles. Electromyogr Clin Neurophysiol 24:99–106, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Auger RG, , Piepgras DG, & Laws ER Jr: Hemifacial spasm: results of microvascular decompression of the facial nerve in 54 patients. Mayo Clin Proc 61:640644, 1986 Auger RG, Piepgras DG, Laws ER Jr: Hemifacial spasm: results of microvascular decompression of the facial nerve in 54 patients. Mayo Clin Proc 61:640–644, 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Domen K, , Saitoh E, & Kimura A, et al: [F wave of the facial nerve: a preliminary on its possible clinical application.] Facial Nerve Res Jpn 10:4144, 1990 (Jpn) Domen K, Saitoh E, Kimura A, et al: [F wave of the facial nerve: a preliminary on its possible clinical application.] Facial Nerve Res Jpn 10:41–44, 1990 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 4.

    Esteban A, & Molina-Negro P: Primary hemifacial spasm: a neurophysiological study. J Neurol Neurosurg Psychiatry 49:5863, 1986 Esteban A, Molina-Negro P: Primary hemifacial spasm: a neurophysiological study. J Neurol Neurosurg Psychiatry 49:58–63, 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Huang CI, , Chen IH, & Lee LS: Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery 30:5357, 1992 Huang CI, Chen IH, Lee LS: Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery 30:53–57, 1992

    • Search Google Scholar
    • Export Citation
  • 6.

    Ishikawa M, , Namiki J, & Takase M, et al: Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci 142:99106, 1996 Ishikawa M, Namiki J, Takase M, et al: Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci 142:99–106, 1996

    • Search Google Scholar
    • Export Citation
  • 7.

    Ishikawa M, , Ohira T, & Namiki J, et al: Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm. J Neurol Sci 137:109116, 1996 Ishikawa M, Ohira T, Namiki J, et al: Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm. J Neurol Sci 137:109–116, 1996

    • Search Google Scholar
    • Export Citation
  • 8.

    Ishikawa M, , Ohira T, & Namiki J, et al: Electophysiological investigation of hemifacial spasm: F-waves of the facial muscles. Acta Neurochir 138:2432, 1996 Ishikawa M, Ohira T, Namiki J, et al: Electophysiological investigation of hemifacial spasm: F-waves of the facial muscles. Acta Neurochir 138:24–32, 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Ishikawa M, , Ohira T, & Namiki J, et al: F-wave in patients with hemifacial spasm: observations during microvascular decompression operations. Neurol Res 18:28, 1996 Ishikawa M, Ohira T, Namiki J, et al: F-wave in patients with hemifacial spasm: observations during microvascular decompression operations. Neurol Res 18:2–8, 1996

    • Search Google Scholar
    • Export Citation
  • 10.

    Iwakuma T, , Matsumoto A, & Nakamura N: Hemifacial spasm. Comparison of three different operative procedures in 110 patients. J Neurosurg 57:753756, 1982 Iwakuma T, Matsumoto A, Nakamura N: Hemifacial spasm. Comparison of three different operative procedures in 110 patients. J Neurosurg 57:753–756, 1982

    • Search Google Scholar
    • Export Citation
  • 11.

    Jannetta PJ: Cranial rhizopathies, in Youmans JR (ed): Neurological Surgery, ed 3. Philadelphia: WB Saunders, 1990, Vol 6, pp 41694182 Jannetta PJ: Cranial rhizopathies, in Youmans JR (ed): Neurological Surgery, ed 3. Philadelphia: WB Saunders, 1990, Vol 6, pp 4169–4182

    • Search Google Scholar
    • Export Citation
  • 12.

    Kimura J: The blink reflex as a clinical test, in Aminoff MJ (ed): Electrodiagnosis in Clinical Neurology, ed 3. New York: Churchill Livingstone, 1992, pp 13691402 Kimura J: The blink reflex as a clinical test, in Aminoff MJ (ed): Electrodiagnosis in Clinical Neurology, ed 3. New York: Churchill Livingstone, 1992, pp 1369–1402

    • Search Google Scholar
    • Export Citation
  • 13.

    Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice, ed 2. Philadelphia: FA Davis, 1989, pp 332355 Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice, ed 2. Philadelphia: FA Davis, 1989, pp 332–355

    • Search Google Scholar
    • Export Citation
  • 14.

    Kuroki A, & Møller AR: Facial nerve demyelination and vascular compression are both needed to induce facial hyperactivity: a study in rats. Acta Neurochir 126:149157, 1994 Kuroki A, Møller AR: Facial nerve demyelination and vascular compression are both needed to induce facial hyperactivity: a study in rats. Acta Neurochir 126:149–157, 1994

    • Search Google Scholar
    • Export Citation
  • 15.

    Kuroki A, , Møller AR, & Saito S: Recordings from the facial motonucleus in rats with signs of hemifacial spasm. Neurol Res 16:389392, 1994 Kuroki A, Møller AR, Saito S: Recordings from the facial motonucleus in rats with signs of hemifacial spasm. Neurol Res 16:389–392, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Møller AR: The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta Neurochir 113:2430, 1991 Møller AR: The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta Neurochir 113:24–30, 1991

    • Search Google Scholar
    • Export Citation
  • 17.

    Møller AR: Interaction between the blink reflex and the abnormal muscle response in patients with hemifacial spasm: results of intraoperative recordings. J Neurol Sci 101:114123, 1991 Møller AR: Interaction between the blink reflex and the abnormal muscle response in patients with hemifacial spasm: results of intraoperative recordings. J Neurol Sci 101:114–123, 1991

    • Search Google Scholar
    • Export Citation
  • 18.

    Møller AR, & Jannetta PJ: Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66:681685, 1987 Møller AR, Jannetta PJ: Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66:681–685, 1987

    • Search Google Scholar
    • Export Citation
  • 19.

    Møller AR, & Jannetta PJ: On the origin of synkinesis in hemifacial spasm: results of intracranial recordings. J Neurosurg 61:569576, 1984 Møller AR, Jannetta PJ: On the origin of synkinesis in hemifacial spasm: results of intracranial recordings. J Neurosurg 61:569–576, 1984

    • Search Google Scholar
    • Export Citation
  • 20.

    Møller AR, & Sen CN: Recordings from the facial nucleus in the rat: signs of abnormal facial muscle response. Exp Brain Res 81:1824, 1990 Møller AR, Sen CN: Recordings from the facial nucleus in the rat: signs of abnormal facial muscle response. Exp Brain Res 81:18–24, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Namiki J: [The value of measuring the F wave of facial muscles in an experimental model of intratemporal facial nerve palsy.] Keio Igaku 72:177188, 1995 (Jpn) Namiki J: [The value of measuring the F wave of facial muscles in an experimental model of intratemporal facial nerve palsy.] Keio Igaku 72:177–188, 1995 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 22.

    Namiki J, , Ajimi Y, & Tamura K, et al: [F wave of the facial muscle in cat—recordings by surface electrodes.] Facial Nerve Res Jpn 10:3740, 1990 (Jpn) Namiki J, Ajimi Y, Tamura K, et al: [F wave of the facial muscle in cat—recordings by surface electrodes.] Facial Nerve Res Jpn 10:37–40, 1990 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 23.

    Namiki J, , Domen K, & Saito E, et al: [F wave of the facial muscles in patients with hemifacial spasm.] Facial Nerve Res Jpn 11:6368, 1991 (Jpn) Namiki J, Domen K, Saito E, et al: [F wave of the facial muscles in patients with hemifacial spasm.] Facial Nerve Res Jpn 11:63–68, 1991 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 24.

    Namiki J, , Nakatsukasa M, & Ajimi Y, et al: [F wave of the facial muscle in cat.] Facial Nerve Res Jpn 9:3538, 1989 (Jpn) Namiki J, Nakatsukasa M, Ajimi Y, et al: [F wave of the facial muscle in cat.] Facial Nerve Res Jpn 9:35–38, 1989 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 25.

    Nielsen VK: Electrophysiology of the facial nerve in hemifacial spasm: ectopic/ephaptic excitation. Muscle Nerve 8:545555, 1985 Nielsen VK: Electrophysiology of the facial nerve in hemifacial spasm: ectopic/ephaptic excitation. Muscle Nerve 8:545–555, 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Nielsen VK: Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology 34:418426, 1984 Nielsen VK: Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology 34:418–426, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Rasminsky M: Ephaptic transmission between single nerve fibres in the spinal nerve roots of dystrophic mice. J Physiol 305:151169, 1980 Rasminsky M: Ephaptic transmission between single nerve fibres in the spinal nerve roots of dystrophic mice. J Physiol 305:151–169, 1980

    • Search Google Scholar
    • Export Citation
  • 28.

    Roth G, , Magistris MR, & Pinelli P, et al: Cryptogenic hemifacial spasm. A neurophysiological study. Electromyogr Clin Neurophysiol 30:361370, 1990 Roth G, Magistris MR, Pinelli P, et al: Cryptogenic hemifacial spasm. A neurophysiological study. Electromyogr Clin Neurophysiol 30:361–370, 1990

    • Search Google Scholar
    • Export Citation
  • 29.

    Saito S, & Møller AR: Chronic electrical stimulation of the facial nerve causes signs of facial nucleus hyperactivity. Neurol Res 15:225231, 1993 Saito S, Møller AR: Chronic electrical stimulation of the facial nerve causes signs of facial nucleus hyperactivity. Neurol Res 15:225–231, 1993

    • Search Google Scholar
    • Export Citation
  • 30.

    Sawnhey BB, & Kayan A: A study of the F wave from the facial muscles. Electromyography 10:287295, 1970 Sawnhey BB, Kayan A: A study of the F wave from the facial muscles. Electromyography 10:287–295, 1970

    • Search Google Scholar
    • Export Citation
  • 31.

    Sen CN, & Møller AR: Signs of hemifacial spasm created by chronic periodic stimulation of the facial nerve in the rat. Exp Neurol 98:336349, 1987 Sen CN, Møller AR: Signs of hemifacial spasm created by chronic periodic stimulation of the facial nerve in the rat. Exp Neurol 98:336–349, 1987

    • Search Google Scholar
    • Export Citation
  • 32.

    Trontelj JV, & Trontelj M: F-responses of human facial muscles. A single motoneurone study. J Neurol Sci 20:211222, 1973 Trontelj JV, Trontelj M: F-responses of human facial muscles. A single motoneurone study. J Neurol Sci 20:211–222, 1973

    • Search Google Scholar
    • Export Citation
  • 33.

    Valls-Sole J, & Tolosa ES: Blink reflex excitability cycle in hemifacial spasm. Neurology 39:10611066, 1989 Valls-Sole J, Tolosa ES: Blink reflex excitability cycle in hemifacial spasm. Neurology 39:1061–1066, 1989

    • Search Google Scholar
    • Export Citation
  • 34.

    Zappia M, , Valentino P, & Marchello LP, et al: F-wave normative studies in different nerves of healthy subjects. Electroenceph Clin Neurophysiol 89:6772, 1993 Zappia M, Valentino P, Marchello LP, et al: F-wave normative studies in different nerves of healthy subjects. Electroenceph Clin Neurophysiol 89:67–72, 1993

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 502 142 11
Full Text Views 151 16 1
PDF Downloads 106 14 1
EPUB Downloads 0 0 0