Clinico-radiologic correlation in unilateral and bilateral hemifacial spasm

INTRODUCTION: Bilateral hemifacial spasm (HFS) is rare. Clinico-radiologic correlates utilizing advanced imaging techniques have not been systematically examined in bilateral HFS. The prevalence of bilateral HFS in an Asian population has not been clarified. OBJECTIVES: We examined the prevalence and clinico-radiologic correlates of bilateral HFS in a clinic-based cohort and compared the clinical characteristics of unilateral HFS patients with and without contralateral neurovascular contact (NVC) in HFS. METHODS: Patients clinically diagnosed with HFS were examined for bilateral symptoms. Imaging analysis involved the utilization of reformatted, multi-planar three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA), and constructive interference at steady state (CISS-MR) sequences. The clinical and imaging data was compared between HFS with and without NVC. RESULTS: Amongst 162 consecutive HFS patients, 2 (1.6%) had bilateral symptoms. Both patients had unilateral onset followed by bilateral and asynchronous facial contractions. The contralateral side of the face began to twitch at a mean of 1.5 years later. MRI/A revealed significant NVC of the root exit zone (REZ) of the facial nerve on the ipsilateral side with mild NVC contralaterally. The degree of NVC correlated with the clinical severity of the patients' symptoms. MRI/A analysis of 40 HFS patients with unilateral symptoms demonstrated NVC on the contralateral side in six patients (15%). The mean age and duration of symptoms were not different between HFS patients with and without contralateral NVC. CONCLUSIONS: We demonstrated clinico-radiologic correlation between the clinical severity and the degree of NVC at the REZ of the facial nerve in bilateral HFS. Amongst unilateral HFS, there was no significant difference clinically between those with and without contralateral NVC. The low 1.6% prevalence of bilateral HFS in our Asian cohort was compatible with the rare prevalence in other ethnic populations.     

A case-controlled MRI/MRA study of neurovascular contact in hemifacial spasm

BACKGROUND: Neurovascular contact (NVC) with the root exit zone (REZ) of the ipsilateral facial nerve is associated with hemifacial spasm (HFS), but unresolved issues remain. OBJECTIVES: To 1) determine the frequency of symptomatic and nonsymptomatic NVC, 2) determine the features of NVC associated with HFS, and 3) correlate severity of HFS to these features. METHODS: Two independent, blinded, prospective assessments of high-resolution MR and MR angiography (MRA) images were performed on Chinese cases (HFS: n = 44; age-matched control subjects: n = 20). RESULTS: Over 88% of 44 symptomatic sides in patients with HFS had NVC of the ipsilateral facial nerve. At least 80% of symptomatic sides involved NVC at the anterior aspect of the REZ [REZ(ant.)]. Although NVC was observed in approximately half of nonsymptomatic sides, at least 70% of them were not at REZ(ant.). NVC at the cisternal and intracanalicular portions of the facial nerve were not associated with HFS. Half of our patients with HFS had bilateral NVC, but none had bilateral symptoms. Most of our MR/MRA images showed that the size and position of the arterial branches of the vertebrobasilar system were markedly asymmetric. Of patients with bilateral NVC, over 83% had asymmetric NVC sites. The anterior inferior cerebellar artery was the most common vessel involved in NVC, but was not significantly associated with HFS. Most of the NVC involved one vessel at one contact point with no indentation. The development of HFS was significantly associated with nerve indentation in NVC. The development and severity of HFS were not associated with multiple contact points in NVC. No significant interobserver variability existed between the blinded assessments. CONCLUSIONS: MRI/MR angiography are accurate, fast, and safe in characterizing neurovascular contact (NVC) at the brainstem. The site of NVC and ipsilateral facial nerve indentation in NVC are significant determinants for the development of hemifacial spasm (HFS). The lack of bilateral NVC at the anterior aspect of the root exit zone of the facial nerve could explain in part the lack of bilateral symptoms. The development and severity of HFS are not associated with a specific blood vessel or multiple contact points in NVC.     

微血管减压术治疗青年面肌痉挛的临床分析

目的:本文通过对21例青年面肌痉挛(hemifacialspasm,HFS)手术病例的回顾性分析,总结微血管减压手术治疗青年HFS的特点及术后随访结果。方法:我科自2001年1月-2004年8月共收治HFS患者311例,回顾总结其中21例起病年龄<28岁的青年HFS患者的手术发现以及术后随访结果。结果:本组21例患者均于术中发现存在明确的责任血管压迫面神经REZ区,且责任血管均为动脉。术后症状完全缓解率90.5%。结论:动脉压迫面神经REZ区仍是导致青年HFS发生的最主要原因。微血管减压治疗青年HFS,术后症状完全缓解率高、效果稳定、复发率低。     

A comparative study of primary and secondary hemifacial spasm

BACKGROUND: Hemifacial spasm (HFS) is a common movement disorder. OBJECTIVE: To evaluate possible differences in the demographic and clinical features between primary and secondary HFS. DESIGN: In-person interview using a standardized questionnaire to collect demographic and clinical data. SETTING: A multicenter study that included patients with HFS attending 3 Italian academic centers.Patients Two hundred fourteen patients with HFS. MAIN OUTCOME MEASURE: A complete neurological examination assessed the current muscle distribution of spasm and the presence of synkinetic movements between upper and lower facial muscles. RESULTS: The study sample comprised 214 patients with HFS, 81 men and 133 women, having a mean +/- SD age of 65.9 +/- 12.3 years; 164 patients were classified as having primary HFS and 50 patients (48 postparalytic and 2 symptomatic cases) were classified as having secondary HFS. Patients with primary and those with secondary HFS had similar mean +/- SD ages at onset (54.9 +/- 13.5 vs 57.0 +/- 12.8 years), male-female ratios (63:101 vs 18:32), right-sided-left-sided HFS (77:86 [1 bilateral] vs 21:28 [1 bilateral]), and frequencies of familial cases (2.9% vs 2.0%), respectively. Most patients (65.0%) with primary HFS had initial symptoms of periocular muscle contractions alone and had subsequent involvement of the lower facial muscles. Most patients (72.0%) with secondary HFS reported initial involvement of the upper and lower facial muscles simultaneously. Signs of synkinesis were present in primary (43.3%) and secondary (58.0%) HFS. CONCLUSIONS: Patients with primary and those with secondary HFS share common demographic and clinical features, including sex distribution, age at onset, affected side of HFS, synkinesis, and rarity of familial cases. Signs of synkinesis were present in significant proportions of patients with primary or secondary HFS. The 2 forms differed in clinical presentation.     

3D-TOF磁共振血管成像诊断偏侧面肌痉挛的病因

目的　研究 3D TOF磁共振血管成像对偏侧面肌痉挛 (HFS)病因诊断的临床价值。方法　 3D TOF磁共振血管成像脑干薄层扫描 3 4例HFS患者和 3 5例对照 ,盲法诊断面神经根部解剖改变 ,两组对照分析。结果　 ( 1)HFS患者症状侧面神经根部受压迫 3 2侧 ( 94 % ) ,其中血管压迫 3 1侧( 91% ) ,肿瘤压迫 1侧 ( 3 % ) ;无症状侧受血管压迫 6侧 ( 18% ) ;对照组双侧受压迫 3侧 ( 4 % ) ,其中血管 2侧 ,肿瘤 1侧。 ( 2 )常见压迫血管分别为小脑前下动脉 11侧 ( 3 8% ) ,椎动脉单独或与小脑后下动脉联合 9侧 ( 2 9% ) ,小脑后下动脉 8侧 ( 2 5 % )。 ( 3 )面神经根部血管压迫发生HFS相对危险度的估计值为 3 7.2 8。 ( 4 )面肌痉挛侧面神经根部受血管压迫或包绕有 14侧 ( 4 5 % )。结论　研究提示 ,3D TOF磁共振血管成像为目前面肌痉挛病因诊断的最佳影像检查方法 ,HFS的主要病因为患侧面神经根部受血管压迫、包绕或与其紧密接触。     

Young onset Hemifacial Spasm in patients with Chiari type I malformation

Hemifacial spasm (HFS) resulting from Chiari type I malformation (CIM) is rare. We retrospectively evaluated five patients with CIM and HFS among a series of 103 subjects. The frequency of HFS associated to CIM was of 4.85%. The clinical profile did not differ from the classical primary cases except for young-onset development of facial spasms in patients with CIM. Three patients were treated with BTX-A injections with favorable outcome. Although rare HFS may be associated with CIM especially in young subjects with peculiar phenotypic characteristics (short neck). Moreover, BTX may be an alternative to posterior fossa decompression in selected cases.     

继发面肌痉挛的显微手术治疗

目的 探讨因肿瘤继发面肌痉挛(HFS)的临床特征和显微手术治疗的要点.方法 回顾性分析1984年10月至2007年3月问作者采用显微手术治疗的小脑脑桥角肿瘤继发的HFS48例的临床资料,并对其中41例进行长期随访.结果 肿瘤大小在1.5～5cm之间,均对面神经出脑干区(REZ)造成不同程度的压迫.肿瘤全切除43例,近全切除3例,部分切除2例.37例(77%)在切除肿瘤后见动脉血管和肿瘤共同压迫面神经REZ,故再以Teflon棉对REZ进行显微血管减压.肿瘤类型为表皮样囊肿37例、脑膜瘤4例、听神经瘤2例、舌咽神经鞘瘤3例及迷走神经鞘瘤2例.41例随访时间4-216个月.HFS症状消失38例,有效2例,复发l例.术后永久并发症8例.结论 除部分表皮样囊肿可以直接压迫面神经导致面肌痉挛外,其他多数肿瘤继发面肌痉挛均由肿瘤和血管共同作用所致.在切除肿瘤后对"责任血管"的探查和有效减压是保证手术疗效的关键.术前影像学检查有助于判定面肌痉挛是否由肿瘤继发.     

面肌痉挛显微血管减压术中的面神经根解剖变异

目地 探讨小脑脑桥角面神经根解剖变异与原发性面肌痉挛的关系及手术治疗.方法 采用显微血管减压术治疗的1221例面肌痉挛病例中,10例(0.82%)术中探查发现面神经根存在解剖变异,面神经根出脑干区距离听神经根进脑干区均大于10mm.均采用显微血管减压术治疗,其中4例术中采用责任动脉悬吊法.结果 9例患者术后面肌痉挛立即消失,1例患者术后痉挛减轻但未消失,随访5个月时完全消失.所有患者随访2-96个月,平均26.8个月,复发1例,治愈率90%.术后并发症包括:中度面瘫2例,1例随访期间恢复正常,1例轻度恢复;展神经麻痹致复视3例,2例随访期间恢复正常,1例仅随访3个月,有好转;患侧听力丧失1例,随访21个月未恢复.结论 小脑脑桥角面神经出脑干区异位至距离听神经进脑干区大于10mm者罕见,动脉性血管压迫仍然是此类患者原发性面肌痉挛的主要病因,采用显微血管减压术治疗可获良效,但术后发生面瘫、展神经麻痹、听力障碍的概率升高.应用责任动脉悬吊法有利于提高疗效、减少并发症.     

Comparing clinical features of young onset,middle onset and late onset Parkinson's disease

BackgroundParkinson's disease (PD) affects 1–2% of the population over 65 years. There is evidence that the clinical features differ with age at symptom onset, but published information is scarce.MethodsWe reviewed the charts of 593 PD patients and divided them into young onset (≤49 years), middle onset (50–69 years) and late onset (≥70 years) groups. Data collected included age at symptom onset, year of onset, family history of Parkinson's disease in first and second degree relatives, predominant first symptom, first anti parkinsonian medication prescribed, frequency of levodopa-induced dyskinesia, therapy related dystonia, therapy related gastrointestinal side effects, hallucination, dementia, depression and apathy.ResultsThe middle onset was the largest group (51%), followed by the late onset (39%) and the young onset (10%) groups. Young onset patients had a more frequent family history of Parkinson's disease and a longer survival. Symptoms other than tremor were more frequent as the initial symptom of the young onset group, and the frequency of tremor as the first symptom increased with advancing age at onset. Depression was more frequent in the young onset group. The frequency of treatment related dyskinesia or dystonia decreased with advancing age at onset.ConclusionWe have identified specific clinical differences in Parkinson's disease related to the patient's age at onset and added to the existing knowledge of the variability of disease presentation. We suggest an age of onset of 49 years or less for the definition of young onset PD.     

Is MVD the effective treatment for poorly controlled hypertension?

BackgroundStudies have shown that microvascular decompression (MVD) surgery could improve the clinical symptoms of hemifacial spasm (HFS) and decrease the blood pressure (BP) in patients with refractory hypertension. More positive long-term results are required to establish MVD as a treatment option for high blood pressure (HBP) and to refine the patient selection criteria.MethodsFrom October 2015 to September 2018, based on patient selection for cases with both HFS and poorly controlled HBP of nervous origin, MVD surgeries were performed on 12 patients aiming for better BP control. The patients were followed-up for at least 2 years. The surgical outcomes and associated factors were analyzed.ResultsWith respect to neurovascular compression (NVC) of facial nerve, the intra-operative findings concurred with pre-operative radiological findings except that in one case. Intra-operatively ipsilateral cranial nerve (CN) IX–X root exit zone (REZ) and rostral ventrolateral medulla (RVLM) NVCs were confirmed and concordant with pre-operative radiological findings in all 12 cases. 9 Of the 12 cases were completely free of facial spasm after surgery. 2 patients achieved partial relief. 1 patient still suffered from frequent facial spasm. 10 out of 12 patients achieved BP lowering after surgery. The BP of those 10 patients stayed at a relatively stable scale over the follow-up period. Although statistical significance was not obtained, for patients who are operated on the left side and those who have only 1 offensive artery, the surgery might lead to better BP control.ConclusionsMVD is a safe and effective treatment for hypertension due to central nervous system (CNS) NVC in patients with both HBP and HFS. Further studies are required to examine long-term outcomes and establish criteria for patient selection.     

Intra-operative neurophysiology during microvascular decompression for hemifacial spasm

There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness. Other neurophysiologic techniques, such as facial F-wave, blink reflex and facial corticobulbar motor evoked potentials (FCoMEP), are feasible to intra-operatively study changes in excitability of the facial nerve and its nucleus during MVDs. Intra-operative neuromonitoring with the mentioned techniques allows a better understanding of HFS pathophysiology and helps to optimise the MVD.     

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

Objective

Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses.

Methods

Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004, the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features, the compression patterns of the vessels at the time of surgery and treatment outcomes.

Results

There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%), and in 27 cases (34.2%) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05).

Conclusion

In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.     

Familial hemifacial spasm and determinants of late onset

The role of hypertension in the late onset of hemifacial spasm (HFS) is evaluated in a family, spanning four generations. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a variable anatomical relationship between nervous and vascular structures in the symptomatic cerebello-pontine angle. In one case, showing neurovascular conflict (NVC), microvascular surgical decompression was followed by clinical resolution of HFS. Neuroimaging suggesting NVC was found in all symptomatic patients of the last two generations and in three younger subjects not affected by HFS. As a determinant for the late development of clinical expression is reviewed the role of arterial hypertension, detected few years before HFS appearing in all symptomatic subjects. The distribution of NVC in several members of the same family suggests a genetic susceptibility towards vascular anomaly.     

Microvascular decompression of the facial nerve for hemifacial spasm in youth

OBJECTS: The goal of this study was to investigate the differences between clinical findings in youth and in adulthood on microvascular decompression (MVD) of the facial nerve for the treatment of hemifacial spasm (HFS). METHODS: We retrospectively evaluated 855 patients who underwent MVD from January 1985 to July 1999. In our series of 33 young HFS patients, all patients had definite offending vessels. Interestingly, pathologic tortuous vertebral artery as a possible etiology was more rarely observed in young HFS patients (1/33 patients, 3.0%) than in adult patients (61/822 patients, 7.4%) (P < 0.05). We did not observe any atomical variations of the vessels or any arachnoidal thickening around the root entry zone and cerebellopontine cistern in youths. Furthermore, young HFS patients did not necessarily have poorer surgical outcomes than adult HFS patients. CONCLUSIONS: Our results suggest that the cause and progress of HFS are the same in youth as in adulthood, even though the pathogenesis of early onset remains unclear.     

Comparison of the natural history and prognostic features of early onset and adult onset multiple sclerosis in Jordanian population

OBJECTIVES: To assess the natural history and prognostic features of early onset multiple sclerosis (EOMS) and adult onset multiple sclerosis (AOMS) in Jordanian population. PATIENTS AND METHODS: A retrospective analysis of 253 multiple sclerosis (MS) patients treated at the three major referral centers for MS in Jordan was performed. Twenty-six patients were excluded due to lack of follow up details. Patients under (or equal to) the age of 18 years were considered as EOMS. Clinical features of the two groups were compared and statistically analyzed. Time to reach expanded disability status score (EDSS) 3 and time to reach secondary progression were used as end points for survival analysis. Log-rank tests were performed and Kaplan-Meier survival curves were presented. RESULTS: About 44 (19.4%) patients had EOMS. The clinical characteristics of EOMS and AOMS were not significantly different. Most patients (about 88%) had relapsing remitting course. Monosymptomatic presentation was the predominant feature in both groups. Median time to reach EDSS 3 and median time to reach secondary progression were significantly longer in EOMS. Kaplan-Meier survival analysis did not show difference between the two groups. Higher EDSS score at diagnosis, shorter first inter-attack interval, and secondary progressive course were significantly unfavorable prognostic factors for both EOMS and AOMS. CONCLUSIONS: The natural history and prognostic features of EOMS and AOMS are not significantly different in Jordanian population. Therefore, treatment strategies should be the same for the two groups.     

The motor phenotype of Parkinson's disease in relation to age at onset

Background: Parkinson's disease (PD) is heterogeneous and age at onset may define variation in clinical phenotype. Most previous studies have used various age cut‐offs and have been based on clinical case series. Methods: We have studied the association between clinical features and age of onset in 358 community‐based and regional patients with PD. Results: Tremor at presentation is twice as common in those with onset over 64 years as compared to those with onset under 45 (early onset PD ‐ EOPD) and becomes more common with increasing age at onset (p values for trend ≤ 0.004). Dystonia affects 60% of those with EOPD, shows a curvilinear relationship with age at onset (cubic versus linear p=0.01) with highest risk in patients whose disease began before 48 years. In this study age at onset was a strong predictor of the development of dyskinesias, with younger age associated with a higher risk of dyskinesias. Following multivariable analysis, allowing for possibly confounding factors (disease duration, L‐DOPA dosage, L‐DOPA treatment duration) younger age at onset, (less than 55 years) predicted the development of L‐DOPA induced dyskinesia (odds ratio <45 years 2.1, 95% CI 1.0, 4.8; odds ratio < 55 years 3.8, 95% CI 1.8, 8.0). Only 2/70 (2.9%) EOPD patients carried pathogenic parkin or PINK1 mutations and the clinical differences between early and late onset disease were not explained by the presence of mutations in these genes. Discussion: This study highlights the clinical differences between early and late onset PD, which have important implications for diagnosis and management. © 2011 Movement Disorder Society     

Distinguishing features of psychogenic (functional) versus organic hemifacial spasm

Hemifacial spasm (HFS) is one of the most common presentations in patients with cranial psychogenic (functional) movement disorders (PMD). Medical records and videos of patients with PMD and HFS were reviewed to identify those with psychogenic HFS and to compare the phenomenology of psychogenic HFS with organic HFS. We identified 18 (9.8%) patients with psychogenic HFS from a cohort of 184 patients with PMDs. There were 14 (78%) women and 4 men, with a mean age at onset of 33 ± 13.5 years. These were compared with 37 consecutive patients with organic (primary) HFS. Patients with psychogenic HFS were significantly younger and had more frequently tonic muscle contractions, bilateral asynchronous hemifacial involvement, isolated lower facial involvement, downward deviation of the mouth’s angle, and lack of the “other Babinski sign” compared to those with organic HFS. Other features such as ipsilateral downward movements of the eyebrow; associated tremor, dystonia and hemi-masticatory spasms were more frequently observed in patients with psychogenic HFS but these differences did not reach statistical significance. Lack of other Babinski sign and tonic muscle contractions showed the highest sensitivity (1.00 and 0.87, respectively), whereas downward mouth’s angle deviation showed the highest specificity (1.00) for the diagnosis of psychogenic HFS. Besides other features such as suggestibility, distractibility, periods of unexplained improvements observed in most patients with PMDs, several clinical features, such as tonic muscle contractions, downward mouth’s angle deviation, predominant lower facial and bilateral involvement, may be helpful in distinguishing psychogenic from organic HFS.     

高分辨率强化3D - SPGR序列评价三叉神经痛患者神经血管的关系

目的 探讨强化三维损毁梯度回波( 3D - SPGR)序列检出三叉神经痛(TN)患者神经血管压迫(NVC)的能力.方法 对37例TN患者行强化3D- SPGR序列扫描,由高年资神经影像学医师评价三叉神经根进入区(REZ)神经与血管的关系,并与显微血管减压术(MVD)术中观察的结果对比.结果 37例患者中,MVD证实36例存在NVC,强化3D-SPGR显示了35例,其敏感性为97.2％,特异性为100％,且MRI所显示的责任血管位置与MVD之间有高度的一致性(K=0.81).在14例三叉神经上颌支疼痛的患者中,12例(85.7％)的NVC位于REZ的内侧,而在16例下颌支疼痛的患者中,13例(81.3％)的NVC位于REZ的外侧,两者之间的差异有统计学意义(P＜0.001).结论 强化3D - SPGR序列是检出TN患者NVC有效的检查方法,将为MVD术前制定治疗方案提供有价值的信息.     

Hemifacial spasm: Clinical findings and treatment

Hemifacial spasm (HFS) is a peripherally induced movement disorder characterized by involuntary, unilateral, intermittent, irregular, tonic or clonic contractions of muscles innervated by the ipsilateral facial nerve. We reviewed the clinical features and response to different treatments in 158 patients (61% women) with HFS evaluated at our Movement Disorders Clinic. The mean age at onset was 48.5 ± 14.1 years (range: 15–87) and the mean duration of symptoms was 11.4 ± 8.5 (range: 0.5–53) years. The left side was affected in 56% instances; 5 patients had bilateral HFS. The lower lid was the most common site of the initial involvement followed by cheek and perioral region. Involuntary eye closure which interfered with vision and social embarrassment were the most common complaints. HFS was associated with trigeminal neuralgia in 5.1% of the cases and 5.7% had prior history of Bell's palsy. Although vascular abnormalities, facial nerve injury, and intracranial tumor were responsible for symptoms in some patients, most patients had no apparent etiology. Botulinum toxin type A(BTX-A)injections, used in 110 patients, provided marked to moderate improvement in 95% of patients. Seven of the 25 (28%) patients who had microvascular decompression reported permanent complications and the HFS recurred in 5 (20%). Although occasionally troublesome, HFS is generally a benign disorder that can be treated effectively with either BTX-A or microvascular decompression. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21: 1740–1747, 1998     

Association between age at onset and clinical features of schizophrenia: The Northern Finland 1966 birth cohort study

PURPOSE: To study the association between age at onset and the clinical picture of schizophrenia in an unselected young birth cohort. SUBJECTS AND METHODS: The study sample consists of 98 (64 males and 34 females) individuals with DSM-III-R schizophrenia collected from the Northern Finland 1966 birth cohort. Firstly, subjects were divided into very early- and young-onset subgroups by using the median age at onset (22 years in males and 20 in females), as a cut-off point. Secondly, we used age at onset as a continuous variable. Clinical features of schizophrenia were assessed using the Operational Criteria Checklist for Psychotic Illnesses (OCCPI). RESULTS: Inappropriate affect, positive thought disorder and deterioration from premorbid level of function associate with very early-onset schizophrenia, while slowed activity and dysphoria relate to young-onset. These symptoms correlate significantly with the age at onset. DISCUSSION: Differences in the clinical picture associating to the age at onset of schizophrenia are seen early. CONCLUSION: These findings indicate that certain symptoms of schizophrenia are dependent on the age at onset, and schizophrenia occurring initially in early life has some typical features. Using the age at onset as a continuous variable is independent of arbitrary cut-off points and produces more explicable results.