Decompression Surgery in Elderly Patients with Hemifacial Spasm Refractory to Botulinum Toxin.

IF 2.6 4区医学 Q2 CLINICAL NEUROLOGY

Movement Disorders Clinical Practice Pub Date : 2024-08-01 Epub Date: 2024-05-23 DOI:10.1002/mdc3.14064

Margaret Tugend, Christina M Ulane, Kevin Patel, Raymond F Sekula

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Abstract

Background: Botulinum toxin is an effective treatment for hemifacial spasm in elderly patients. However, some patients do not tolerate the side effects and frequency of botulinum toxin treatments.

Objectives: The purpose of this study was to evaluate the characteristics and outcomes of a cohort of elderly patients referred by neurologists for surgical decompression of the facial nerve following botulinum toxin treatment.

Methods: In a prospective cohort study, logistic regression was used to detect potential predictors of spasm-freedom after surgical decompression of the facial nerve in elderly patients that received ≤8 and >8 botulinum toxin treatments for hemifacial spasm before surgery. Age, sex, side, preoperative symptom duration, and preoperative botulinum toxin treatment were assessed as potential predictors of spasm-freedom at last follow-up.

Results: Of 76 elderly patients with hemifacial spasm treated with botulinum toxin and microvascular decompression, with at least 2-years of follow-up (median, 44.5 months), 84.2% were spasm-free at last follow-up. Age (P = 0.38), sex (P = 0.59), side (P = 0.15), preoperative symptom duration (P = 0.7), and number of preoperative botulinum toxin treatments (P = 0.3) were not predictors of long-term spasm-freedom. Permanent ipsilateral hearing loss was the most frequent complication (3.9%).

Conclusion: This study provides evidence that elderly patients can undergo botulinum toxin treatment for hemifacial spasm without compromising their likelihood of achieving spasm-freedom with future surgical decompression. Therefore, surgical decompression of the facial nerve is an effective therapy for elderly patients with hemifacial spasm refractory to botulinum toxin.

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肉毒杆菌毒素难治性面肌痉挛老年患者的减压手术。

背景介绍肉毒杆菌毒素是治疗老年半面痉挛的有效方法。然而，有些患者无法忍受肉毒杆菌毒素治疗的副作用和频率：本研究的目的是评估由神经科医生转诊、接受肉毒杆菌毒素治疗后进行面神经手术减压的老年患者群体的特征和疗效：方法：在一项前瞻性队列研究中，采用逻辑回归法检测术前接受过≤8次和>8次肉毒毒素治疗的半面痉挛老年患者在面神经手术减压后解除痉挛的潜在预测因素。年龄、性别、病侧、术前症状持续时间和术前肉毒素治疗被评估为最后一次随访时解除痉挛的潜在预测因素：76名老年半面肌痉挛患者接受了肉毒杆菌毒素和微血管减压术治疗，随访至少2年（中位数为44.5个月），其中84.2%的患者在最后一次随访时无痉挛。年龄（P = 0.38）、性别（P = 0.59）、患侧（P = 0.15）、术前症状持续时间（P = 0.7）和术前肉毒杆菌毒素治疗次数（P = 0.3）均不是长期无痉挛的预测因素。永久性同侧听力损失是最常见的并发症（3.9%）：本研究提供的证据表明，老年患者可以接受肉毒杆菌毒素治疗半面肌痉挛，而不会影响他们将来通过手术减压达到解除痉挛的可能性。因此，对于肉毒杆菌毒素难治性半面痉挛的老年患者来说，面神经手术减压是一种有效的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Movement Disorders Clinical Practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

7.50%

发文量

218

期刊介绍： Movement Disorders Clinical Practice- is an online-only journal committed to publishing high quality peer reviewed articles related to clinical aspects of movement disorders which broadly include phenomenology (interesting case/case series/rarities), investigative (for e.g- genetics, imaging), translational (phenotype-genotype or other) and treatment aspects (clinical guidelines, diagnostic and treatment algorithms)