title: Hemifacial spasm in Singapore: clinical characteristics and patients ' perceptions.
abstract: BACKGROUND
  The aim of this study was to determine the clinical characteristics and patients ' perception of hemifacial spasm (HFS) in Singapore.
  
  
  METHODS
  A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken.
  
  
  RESULTS
  Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8 % of patients, and the orbicularis oculi was the first muscle to be affected in 86.1 % of them. The majority (65 %) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2 % of the patients, rendered 65 % of them depressed, affected the vision in 60.6 % of them and compromised their work performance in 35.8 %. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3 %) tried traditional therapies (acupuncture or herbal medicine), while only 48.2 % had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90 % showed improvement at 1 month posttreatment.
  
  
  CONCLUSIONS
  The clinical characteristics and patients ' perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: W L
authors.initials: WL
authors.lastname: Au
authors.forename: L C S
authors.initials: LC
authors.lastname: Tan
authors.forename: A K Y
authors.initials: AK
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications; D001294:Attitude to Health; D005260:Female; D019569:Hemifacial Spasm / Q000175:diagnosis / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012846:Singapore; D013315:Stress, Psychological / Q000150:complications