Facial motor evoked potential with paired transcranial magnetic stimulation: prognostic value following microvascular decompression for hemifacial spasm

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OBJECTIVE

Microvascular decompression (MVD) is widely considered the treatment of choice for hemifacial spasm (HFS), but not all patients immediately benefit from it. Numerous electrophysiological tests have been employed to monitor the integrity of the facial nerve prior to, during, and after MVD treatment. The authors sought to verify if facial motor evoked potential (FMEP) with paired transcranial magnetic stimulation (pTMS) can be utilized as a tool to predict prognosis following MVD for HFS.

METHODS

FMEP using pTMS was performed preoperatively and postoperatively for 527 HFS patients who underwent an MVD treatment. Various interstimuli intervals (ISIs), which included 2, 10, 20, 25, 30, 75, and 100 msec, were applied for each paired stimulation and pTMS(%) was obtained. A graph of pTMS(%) versus each ISI was drawn for every patient and its pattern was analyzed in accordance with patients’ clinical outcomes.

RESULTS

With ISIs of 75 and 100 msec, pTMS(%) was physiologically further inhibited, whereas it was relatively facilitated under ISIs of 20, 25, and 30 msec; loss of this specific pattern, that is, further inhibition-relative facilitation, indicated impaired integrity of the facial nerve. Those patients who immediately benefited from an MVD and experienced no relapse tended to show proper restoration of this further inhibition-relative facilitation pattern (p = 0.01). Greater resemblance between the physiological pattern of pTMS(%) and postoperative pTMS(%) was correlated to better outcome (p = 0.019).

CONCLUSIONS

A simple linear graph of pTMS(%) versus each ISI may be a helpful tool to predict prognosis for HFS following an MVD.

ABBREVIATIONS FMEP = facial motor evoked potential; HFS = hemifacial spasm; IFR = inhibited-facilitated ratio; ISI = interstimuli interval; LSR = lateral spread response; MEP = motor evoked potential; MVD = microvascular decompression; PPR = perioperative pTMS(%) ratio; pTMS = paired transcranial magnetic stimulation; REZ = root entry zone; TMS = transcranial magnetic stimulation.
Article Information

Contributor Notes

Correspondence Kwan Park: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. kwanpark@skku.edu.INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.8.JNS18708.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Barker ATJalinous RFreeston IL: Non-invasive magnetic stimulation of human motor cortex. Lancet 1:110611071985

  • 2

    Barker FG IIJannetta PJBissonette DJShields PTLarkins MVJho HD: Microvascular decompression for hemifacial spasm. J Neurosurg 82:2012101995

    • Search Google Scholar
    • Export Citation
  • 3

    Chandler SHTal M: The effects of brain stem transections on the neuronal networks responsible for rhythmical jaw muscle activity in the guinea pig. J Neurosci 6:183118421986

    • Search Google Scholar
    • Export Citation
  • 4

    Ferguson JH: Hemifacial spasm and the facial nucleus. Ann Neurol 4:971031978

  • 5

    Fukuda MOishi MHiraishi TFujii Y: Facial nerve motor-evoked potential monitoring during microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry 81:5195232010

    • Search Google Scholar
    • Export Citation
  • 6

    Hatem JSindou MVial C: Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series. Br J Neurosurg 15:4964992001

    • Search Google Scholar
    • Export Citation
  • 7

    Haug BAKukowski B: Latency and duration of the muscle silent period following transcranial magnetic stimulation in multiple sclerosis, cerebral ischemia, and other upper motoneuron lesions. Neurology 44:9369401994

    • Search Google Scholar
    • Export Citation
  • 8

    Huang BRChang CNHsu JC: Intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm. J Clin Neurosci 16:2092132009

    • Search Google Scholar
    • Export Citation
  • 9

    Ishikawa MOhira TNamiki JGotoh KTakase MToya S: Electrophysiological investigation of hemifacial spasm: F-waves of the facial muscles. Acta Neurochir (Wien) 138:24321996

    • Search Google Scholar
    • Export Citation
  • 10

    Jo KWKong DSPark K: Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36:2973022013

    • Search Google Scholar
    • Export Citation
  • 11

    Joo WILee KJPark HKChough CKRha HK: Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 15:133513392008

    • Search Google Scholar
    • Export Citation
  • 12

    Kim CHKong DSLee JAPark K: The potential value of the disappearance of the lateral spread response during microvascular decompression for predicting the clinical outcome of hemifacial spasms: a prospective study. Neurosurgery 67:158115882010

    • Search Google Scholar
    • Export Citation
  • 13

    Kiya NBannur UYamauchi AYoshida KKato YKanno T: Monitoring of facial evoked EMG for hemifacial spasm: a critical analysis of its prognostic value. Acta Neurochir (Wien) 143:3653682001

    • Search Google Scholar
    • Export Citation
  • 14

    Kobayashi MPascual-Leone A: Transcranial magnetic stimulation in neurology. Lancet Neurol 2:1451562003

  • 15

    Kojima AOhira TTakase MKawase T: Long-latency response to transcranial magnetic stimulation in patients with hemifacial spasm. Electroencephalogr Clin Neurophysiol 109:2852891998

    • Search Google Scholar
    • Export Citation
  • 16

    Kolta AWestberg KGLund JP: Identification of brainstem interneurons projecting to the trigeminal motor nucleus and adjacent structures in the rabbit. J Chem Neuroanat 19:1751952000

    • Search Google Scholar
    • Export Citation
  • 17

    Kong DSPark KShin BGLee JAEum DO: Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg 106:3843872007

    • Search Google Scholar
    • Export Citation
  • 18

    Kujirai TCaramia MDRothwell JCDay BLThompson PDFerbert A: Corticocortical inhibition in human motor cortex. J Physiol 471:5015191993

    • Search Google Scholar
    • Export Citation
  • 19

    Küypers HG: Corticobular connexions to the pons and lower brain-stem in man: an anatomical study. Brain 81:3643881958

  • 20

    Laskawi RDamenz WRoggenkämper PSchröder MBrauneis J: [Magnetic stimulation in patients with facial hemispasm.] Laryngorhinootologie 69:2372411990 (Ger)

    • Search Google Scholar
    • Export Citation
  • 21

    Meyer BURöricht SGräfin von Einsiedel HKruggel FWeindl A: Inhibitory and excitatory interhemispheric transfers between motor cortical areas in normal humans and patients with abnormalities of the corpus callosum. Brain 118:4294401995

    • Search Google Scholar
    • Export Citation
  • 22

    Møller AR: The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta Neurochir (Wien) 113:24301991

  • 23

    Møller ARJannetta PJ: Hemifacial spasm: results of electrophysiologic recording during microvascular decompression operations. Neurology 35:9699741985

    • Search Google Scholar
    • Export Citation
  • 24

    Møller ARJannetta PJ: Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations. Neurosurgery 16:6126181985

    • Search Google Scholar
    • Export Citation
  • 25

    Møller ARJannetta PJ: On the origin of synkinesis in hemifacial spasm: results of intracranial recordings. J Neurosurg 61:5695761984

    • Search Google Scholar
    • Export Citation
  • 26

    Møller ARJannetta PJ: Physiological abnormalities in hemifacial spasm studied during microvascular decompression operations. Exp Neurol 93:5846001986

    • Search Google Scholar
    • Export Citation
  • 27

    Montero JJunyent JCalopa MPovedano MValls-Sole J: Electrophysiological study of ephaptic axono-axonal responses in hemifacial spasm. Muscle Nerve 35:1841882007

    • Search Google Scholar
    • Export Citation
  • 28

    Neves DOLefaucheur JPde Andrade DCHattou MAhdab RAyache SS: A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression. J Neurol Neurosurg Psychiatry 80:137513802009

    • Search Google Scholar
    • Export Citation
  • 29

    Nielsen VK: Pathophysiology of hemifacial spasm: II. Lateral spread of the supraorbital nerve reflex. Neurology 34:4274311984

  • 30

    Oliveri MRossini PMFilippi MMTraversa RCicinelli PPalmieri MG: Time-dependent activation of parieto-frontal networks for directing attention to tactile space. A study with paired transcranial magnetic stimulation pulses in right-brain-damaged patients with extinction. Brain 123:193919472000

    • Search Google Scholar
    • Export Citation
  • 31

    Park JSKong DSLee JAPark K: Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome. Neurosurg Rev 31:4134192008

    • Search Google Scholar
    • Export Citation
  • 32

    Rossini PMRossi S: Clinical applications of motor evoked potentials. Electroencephalogr Clin Neurophysiol 106:1801941998

  • 33

    Samii MGünther TIaconetta GMuehling MVorkapic PSamii A: Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery 50:7127192002

    • Search Google Scholar
    • Export Citation
  • 34

    Schäfer MBiesecker JCSchulze-Bonhage AFerbert A: Transcranial magnetic double stimulation: influence of the intensity of the conditioning stimulus. Electroencephalogr Clin Neurophysiol 105:4624691997

    • Search Google Scholar
    • Export Citation
  • 35

    Sherwood CC: Comparative anatomy of the facial motor nucleus in mammals, with an analysis of neuron numbers in primates. Anat Rec A Discov Mol Cell Evol Biol 287:106710792005

    • Search Google Scholar
    • Export Citation
  • 36

    Tanaka SKogo MChandler SHMatsuya T: Localization of oral-motor rhythmogenic circuits in the isolated rat brainstem preparation. Brain Res 821:1901991999

    • Search Google Scholar
    • Export Citation
  • 37

    von Eckardstein KHarper CCastner MLink M: The significance of intraoperative electromyographic “lateral spread” in predicting outcome of microvascular decompression for hemifacial spasm. J Neurol Surg B Skull Base 75:1982032014

    • Search Google Scholar
    • Export Citation
  • 38

    Weber MEisen AA: Magnetic stimulation of the central and peripheral nervous systems. Muscle Nerve 25:1601752002

  • 39

    Wilkinson MFKaufmann AM: Facial motor neuron excitability in hemifacial spasm: a facial MEP study. Can J Neurol Sci 41:2392452014

    • Search Google Scholar
    • Export Citation
  • 40

    Wilkinson MFKaufmann AM: Monitoring of facial muscle motor evoked potentials during microvascular decompression for hemifacial spasm: evidence of changes in motor neuron excitability. J Neurosurg 103:64692005

    • Search Google Scholar
    • Export Citation
  • 41

    Xia LZhong JZhu JDou NNLiu MXLi ST: Delayed relief of hemifacial spasm after microvascular decompression. J Craniofac Surg 26:4084102015

    • Search Google Scholar
    • Export Citation
  • 42

    Yamashita SKawaguchi TFukuda MSuzuki KWatanabe MTanaka R: Lateral spread response elicited by double stimulation in patients with hemifacial spasm. Muscle Nerve 25:8458492002

    • Search Google Scholar
    • Export Citation
  • 43

    Yamashita SKawaguchi TFukuda MWatanabe MTanaka RKameyama S: Abnormal muscle response monitoring during microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 147:9339382005

    • Search Google Scholar
    • Export Citation
  • 44

    Youman J: Neurological Surgery: A Comprehensive Reference Guide to the Diagnosis and Management of Neurosurgical Problems. Philadelphia: Saunders1996

    • Search Google Scholar
    • Export Citation
  • 45

    Ziemann URothwell JCRidding MC: Interaction between intracortical inhibition and facilitation in human motor cortex. J Physiol 496:8738811996

    • Search Google Scholar
    • Export Citation
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