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KMID : 0359719980160060859
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Journal of the Korean Neurological Association
1998 Volume.16 No. 6 p.859 ~ p.865
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Blink Reflex in Patients with Hemifacial Spasm before and after Botulinum Toxin Treatment
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B.Joon Kim
Won Yong Lee/Min Ky Kim
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Abstract
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Background: Previous blink reflex studies using paired stimulation demonstrated the increased excitability of brainstem interneurons in hemifacial spasm (HFS). We compared the changes in blink reflex before and after botulinum toxin treatment and investigated whether the treatment influenced brainstem interneuronal hyperexcitability.
Methods: In 14 patients with HFS, we performed blink reflex test in 100, 200, and 300ms intervals of paired stimuli before and one month after botulinum toxin injection. We measured the amplitudes of ipsilateral R1 and bilateral R2 responses evoked by conditioning and test stimuli. We compared the amplitude ratio of test to conditioning stimuli in each R1 or R2 response between studies at pre- and post-botulinum toxin treatment.
Results: In preBotox blink reflex studies, ipsilaterla R2 (iR2) responses by test simuli (TS) were detected in 10, 13, and 13 out of 14 patients in affected side, while 3, 9, and 12 in unaffected side at each interval. Differences of amplitude recovery of iR2 responses by TS between two sides were significant (p=0.036, 0.030, 0.007 at each interval), which suggest brainstem interneuronal hyperexcitability at least in affected side. Differences of R1 or contralateral R2 (cR2) responses were not significant. At 100 and 200ms intervals, the recovery indices of iR2 were 22.6% and 40.8% at preBotox, and 12.1% and 24.3% at postBotox studies respectively, which meant reduction of amplitudes were greater significantly at postBotox period (p<0.05). Reductions of R1 and cR2 amplitudes before and after botulinum toxin treatment were not significantly different.
Conclusions: We conclude that brainstem interneuronal hyperexcitability shown by paired stimulation in HFS is reduced by successful botulinum toxin treatment. These results may suggest that botulinum toxin might have a central action. Key words: hemifacial spasm, botulinum toxin, blink reflex
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KEYWORD
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Hemifacial spasm, Botulinum toxin, Blink reflex,
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