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Electrophysiological recordings in bilateral hemifacial spasm
  1. A SCHULZE-BONHAGE,
  2. A FERBERT
  1. Neurologische Klinik, Städtische Kliniken Kassel, Germany
  1. Professor A Ferbert, Klinik für Neurologie, Städtische Kliniken Kassel, Mönchebergstrasse 41–43, D-34125 Kassel, Germany.

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Hemifacial spasm typically consists of unilateral involuntary spasms of the mimic muscles innervated by either facial nerve. There is some controversy whether mechanical irritation of the facial nerve entry zone by vessels in the cerebellopontine angle or hyperexcitability of the facial nerve nucleus is the main cause of this problem.1 2 To our knowledge, only two cases of bilateral hemifacial spasm have been described in some clinical detail but without electrophysiological recordings.3 4 The mechanism underlying the bilateral occurrence of spasms has not been investigated so far: either hyperexcitability of a facial nerve nucleus spreading to the contralateral side or independent mechanical irritation of both nerves might be involved. We report a patient with predominantly left sided spasms, electrophysiological diagnosis of bilateral facial spasm, the clinical course after surgical treatment according to MR evidence of elongated vertebral and basilar arteries, and implications of electrophysiological recordings on the pathogenesis of bilateral hemifacial spasm.

This 60 year old male patient presented with a history of gradually increasing left eye twitching over the past few years. He did not notice involvement of other facial muscles or of associated symptoms such as hearing deficits, vertigo, or headache. Visual inspection showed frequent clonic involuntary synchronous contractions of his left orbicularis oculi and left orbicularis oris muscles. On voluntary contraction of …

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