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NEUROLOGY 2004;62:1749-1752
© 2004 American Academy of Neurology

Trigeminal afferent input alters the excitability of facial motoneurons in hemifacial spasm

K. Ogawara, MD, S. Kuwabara, MD, I. Kamitsukasa, MD, K. Mizobuchi, MD, S. Misawa, MD and T. Hattori, MD

From the Department of Neurology (Drs. Ogawara, Kuwabara, Mizobuchi, Misawa, and Hattori), Chiba University School of Medicine, and Department of Neurology (Dr. Kamitsukasa), Chiba Rosai Hospital, Japan.

Address correspondence and reprint requests to Dr. K. Ogawara, Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; e-mail: ogawarak{at}green.ocn.ne.jp

Objective: To investigate whether skin or muscle afferent input via the trigeminal nerve alters the excitability of facial motoneurons in hemifacial spasm (HFS).

Methods: Botulinum toxin type A (BTX) was injected only to the orbicularis oculi (O. oculi) muscle of 21 patients with idiopathic HFS, and the excitability of the orbicularis oris (O. oris) motoneurons was monitored. The synkinetic response (SR) of the blink reflex and abnormal muscle response (AMR) were recorded from the O. oris before and after treatment.

Results: BTX injections produced marked to moderate improvement in the O. oculi of all 21 patients and in the O. oris of 17 (81%). The rectified areas of SR1 and SR2 were smaller after treatment. In particular, the AMR area showed a reduction (p = 0.02).

Conclusions: The significant lessening of spasms in the O. oris after BTX injection to the O. oculi and the concomitant reduction in excitability of O. oris neurons are consistent with the hypothesis that in HFS, skin or muscle afferent volleys via the trigeminal nerve enhance the excitability of facial nerve motoneurons.

Received March 13, 2003. Accepted in final form January 12, 2004.




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