Hemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of muscles of facial expression which is innervated by the facial nerve. The condition is unilaterally, beginning in the orbicularis occuli, and later on progress to involve the perioral, platysma, and other muscles of facial expression. Endoscopic assisted microvascular decompression is considered the state of the art in hemi-facial spasm surgery. New antiepileptic have emerged with a new hope for good control with few side effects. Botulinum toxin is still a good option for some patients. This study is a prospective study that was conducted on 30 patients with primary hemifacial spasm. Bilateral and secondary cases where excluded. All patients were subjected to proper pre-treatment assessment including; proper history taking, clinical examination, and proper radiological investigations (MRI, FISTA) when needed. They were divided into three groups according to treatment modality: group A where patient's general condition was unfit for surgical intervention, received oral medications (gabapentin or levetiracetam); group B included those patients unfit for surgical intervention and did not respond to oral therapy, received Botox injection; and group C underwent endoscopic assisted microvascular decompression. Follow-up period ranged from 6 to 24 months. Outcome of different treatment modalities were compared among different groups. Among group A patients, one patient showed excellent response to treatment (Gabapentin 1200 mg), three patients had good response, four patients had fair response, and three patients had poor response to treatment (one used levetiracetam, two used gabapentin). Overall success rate is 72.7%. Among group B patients, four patients enjoyed excellent response. Another four patients had good response, while three patients had fair response. Only one patient had poor response. Overall success rate was 83.3%. Among group C patients, five cases had excellent outcome and two cases had good outcome. Overall success rate is 100%. Endoscopic assisted microvascular decompression offers the best chance to permanent cure with low complication rate. New antiepileptics (levetiracetam, gabapentin) provide a safe therapy for patients refusing surgical intervention. Botox is an attractive local therapy with reversible complications but with non-sustainable effect. From our results, we conclude that endoscopic assisted microvascular decompression is superior to either BOTOX or antiepiletics for the permanent cure of hemifacial spasm.

中文翻译：

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内镜辅助微血管减压与新型抗癫痫药和BOTOX联合治疗面肌痉挛：一项临床试验

面肌痉挛（HFS）是一种慢性运动障碍，其特征在于面部神经受支配的面部表情肌肉抽搐。该病是单方面的，始于眼轮虫，后来逐渐累及口周，颈阔肌和其他面部表情肌肉。内镜辅助微血管减压术被认为是半面部痉挛手术的最新技术。已经出现了新的抗癫痫药，希望新药具有良好的控制效果，且副作用很少。肉毒杆菌毒素对于某些患者仍然是一个不错的选择。这项研究是针对30例原发性半面肌痉挛患者进行的前瞻性研究。排除在外的双边和二级案件。所有患者均接受了适当的治疗前评估，包括：适当的病史记录，临床检查，必要时进行适当的放射学检查（MRI，FISTA）。根据治疗方式将其分为三组：A组患者的一般情况不适合手术干预，接受口服药物（加巴喷丁或左乙拉西坦）；B组包括那些不适合手术干预，对口服治疗无反应，接受肉毒杆菌毒素注射的患者；C组行内镜辅助微血管减压术。随访期为6至24个月。在不同组之间比较了不同治疗方式的结果。在A组患者中，一名患者对治疗的反应良好（加巴喷丁1200 mg），三名患者有良好的反应，四名患者有良好的反应，三名患者对治疗的反应较差（一名使用左乙拉西坦，两名使用加巴喷丁）。总体成功率为72.7％。在B组患者中，有4例反应良好。另外四名患者反应良好，而三名患者反应良好。只有一名患者反应较差。总体成功率为83.3％。在C组患者中，有5例具有良好的预后，有2例具有良好的预后。总体成功率为100％。内窥镜辅助的微血管减压术提供了永久治愈的机会，且并发症发生率低。新型抗癫痫药（左乙拉西坦，加巴喷丁）为拒绝手术干预的患者提供了一种安全的疗法。肉毒杆菌素是一种有吸引力的局部疗法，具有可逆的并发症，但效果不可持续。根据我们的结果，