title: Trigeminal afferent input alters the excitability of facial motoneurons in hemifacial spasm.
abstract: OBJECTIVE
  To investigate whether skin or muscle afferent input via the trigeminal nerve alters the excitability of facial motoneurons in hemifacial spasm (HFS).
  
  
  METHODS
  Botulinum toxin type A (BTX) was injected only to the orbicularis oculi (O. oculi) muscle of 21 patients with idiopathic HFS, and the excitability of the orbicularis oris (O. oris) motoneurons was monitored. The synkinetic response (SR) of the blink reflex and abnormal muscle response (AMR) were recorded from the O. oris before and after treatment.
  
  
  RESULTS
  BTX injections produced marked to moderate improvement in the O. oculi of all 21 patients and in the O. oris of 17 (81%). The rectified areas of SR1 and SR2 were smaller after treatment. In particular, the AMR area showed a reduction (p = 0.02).
  
  
  CONCLUSIONS
  The significant lessening of spasms in the O. oris after BTX injection to the O. oculi and the concomitant reduction in excitability of O. oris neurons are consistent with the hypothesis that in HFS, skin or muscle afferent volleys via the trigeminal nerve enhance the excitability of facial nerve motoneurons.
authors.affiliation: Department of Neurology, Chiba University School of Medicine, Japan. ogawarak@green.ocn.ne.jp
authors.forename: K
authors.initials: K
authors.lastname: Ogawara
authors.forename: S
authors.initials: S
authors.lastname: Kuwabara
authors.forename: I
authors.initials: I
authors.lastname: Kamitsukasa
authors.forename: K
authors.initials: K
authors.lastname: Mizobuchi
authors.forename: S
authors.initials: S
authors.lastname: Misawa
authors.forename: T
authors.initials: T
authors.lastname: Hattori
mesh_terms: D000200:Action Potentials; D000328:Adult; D000344:Afferent Pathways / Q000187:drug effects / Q000503:physiopathology; D000368:Aged; D001767:Blinking / Q000187:drug effects / Q000502:physiology; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D004558:Electric Stimulation; D005143:Eyelids / Q000294:innervation; D005152:Facial Muscles / Q000187:drug effects / Q000294:innervation*; D005154:Facial Nerve / Q000503:physiopathology*; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009046:Motor Neurons / Q000187:drug effects / Q000502:physiology*; D011446:Prospective Studies; D012021:Reflex, Abnormal / Q000187:drug effects; D012720:Severity of Illness Index; D012867:Skin / Q000294:innervation; D014276:Trigeminal Nerve / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A