Contributions
Abstract: P876
Type: Poster
Abstract Category: Clinical aspects of MS - MS symptoms
Background: Hemifacial spasm and facial myokymia have been associated with multiple sclerosis, however their etiology and clinical outcome is uncertain.
Objective: To describe clinical and radiological features, along with treatment outcomes of patients with hemifacial spasm and facial myokymia associated with multiple sclerosis.
Methodology: Thirty-six patients with a diagnosis of multiple sclerosis and hemifacial spasm (7) or facial myokymia (29) seen at Mayo Clinic (Rochester, Minnesota, USA) between 1996 and December 2015 were identified by chart review. Case histories; radiologic and electrodiagnostic reports were reviewed.
Results: Twenty five women and eleven men with a median age of 40 (17-66 years old) were reviewed. MS disease duration at the time of symptom onset was 5 and 2 years in cases of FM and HFS, respectively. Clinical course was relapsing remitting MS (75%), secondary progressive MS (17%), and primary progressive MS (3%). A pontine lesion was visible in 83% of cases with brainstem lesions on MRI (14/36). Patients with facial myokymia were treated with steroids (13/29; with benefit in 11/13), carbamazepine (1/29; with benefit in 1/1) and gabapentin (1/29; with benefit in 1/1). Patients with hemifacial spasm were treated with steroids (2/7; with benefit in 1/2), oxcarbazepine (1/7; with benefit in 1/1), carbamazepine (1/7; with benefit in 0/1), gabapentin (1/7; with benefit in 1/1) and botulinum toxin injection (3/7; with benefit in 1/3). Facial myokymia resolved in 26/27 of cases within ten days to three months. One patient had intermittent myokymia for years. Hemifacial spasm resolved in 4/7 patients within 3 months to 7 years. Two patients had persistent hemifacial spasm for up to seven years.
Conclusion: Hemifacial spasm and facial myokymia are more common in relapsing remitting MS when compared to progressive MS. Pontine demyelinating lesions are common. Steroids treatment was associated with symptom improvement in the majority of cases of facial myokymia. Regardless of treatment, the majority of patients with facial myokymia had symptom resolution within 3 months. Botulinum toxin injection treatment was given in cases of hemifacial spasm with partial to good clinical response but other treatments including: intravenous steroids and oral medications could be alternatives.
Disclosure: Nothing to disclose.
Abstract: P876
Type: Poster
Abstract Category: Clinical aspects of MS - MS symptoms
Background: Hemifacial spasm and facial myokymia have been associated with multiple sclerosis, however their etiology and clinical outcome is uncertain.
Objective: To describe clinical and radiological features, along with treatment outcomes of patients with hemifacial spasm and facial myokymia associated with multiple sclerosis.
Methodology: Thirty-six patients with a diagnosis of multiple sclerosis and hemifacial spasm (7) or facial myokymia (29) seen at Mayo Clinic (Rochester, Minnesota, USA) between 1996 and December 2015 were identified by chart review. Case histories; radiologic and electrodiagnostic reports were reviewed.
Results: Twenty five women and eleven men with a median age of 40 (17-66 years old) were reviewed. MS disease duration at the time of symptom onset was 5 and 2 years in cases of FM and HFS, respectively. Clinical course was relapsing remitting MS (75%), secondary progressive MS (17%), and primary progressive MS (3%). A pontine lesion was visible in 83% of cases with brainstem lesions on MRI (14/36). Patients with facial myokymia were treated with steroids (13/29; with benefit in 11/13), carbamazepine (1/29; with benefit in 1/1) and gabapentin (1/29; with benefit in 1/1). Patients with hemifacial spasm were treated with steroids (2/7; with benefit in 1/2), oxcarbazepine (1/7; with benefit in 1/1), carbamazepine (1/7; with benefit in 0/1), gabapentin (1/7; with benefit in 1/1) and botulinum toxin injection (3/7; with benefit in 1/3). Facial myokymia resolved in 26/27 of cases within ten days to three months. One patient had intermittent myokymia for years. Hemifacial spasm resolved in 4/7 patients within 3 months to 7 years. Two patients had persistent hemifacial spasm for up to seven years.
Conclusion: Hemifacial spasm and facial myokymia are more common in relapsing remitting MS when compared to progressive MS. Pontine demyelinating lesions are common. Steroids treatment was associated with symptom improvement in the majority of cases of facial myokymia. Regardless of treatment, the majority of patients with facial myokymia had symptom resolution within 3 months. Botulinum toxin injection treatment was given in cases of hemifacial spasm with partial to good clinical response but other treatments including: intravenous steroids and oral medications could be alternatives.
Disclosure: Nothing to disclose.