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Pathophysiology of hemifacial spasm

III. Effects of facial nerve decompression

From the Department of Neurology, Neuromuscular Laboratory, and the Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA.

We studied 59 patients with hemifacial spasm before decompression of the facial nerve in the cerebellopontine angle. Fifty-three patients were reexamined 1 week later, and 30 patients after 2 to 8 months. Within 1 week, ephaptic transmission disappeared in 23% and changed from bidirectional to unidirectional in 45%. After discharges disappeared in 64% and were mild in 34%. Synkinesis after supraorbital nerve stimulation disappeared in 53%, and the blink reflex amplitude became normal. After 2 to 8 months, ephaptic transmission was abolished in 73% and unidirectional in 17%. After-discharges and synkinesis disappeared in 90%, and the latency of the blink reflex decreased. It is concluded that decompression stops ectopic/ephaptic excitation due to decrease in the interstitial resistance, and enables remyelination.

Address correspondence and reprint requests to Dr. Nielsen, Department of Neurology, 322 Scaife Hall, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15261.

Presented in part at the VII International Congress of Electromyography, Munich, West Germany, 1983.

Accepted for publication November 10, 1983.

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