[Painful tic convulsif and Botulinum toxin].
BACKGROUND
Painful tic convulsif is a rare disorder that associates trigeminal neuralgia (TN) and ipsilateral hemifacial spasm (HFS). These two disorders are the most common examples of hyperactive cranial rhizopathy and are frequently caused by vascular compression of these cranial nerves at the nerve root entry and exit zone in the brain stem, which leads to paroxysmal ephaptic transmission.


METHODS
We report the cases of four patients with combined TN and HFS out of a total of 247 patients with HFS who were treated with botulinum toxin. One patient had TN that was contralateral to the HFS, while the other three were ipsilateral, and one of these had bilateral HFS. In all four cases both the HFS and the TN improved with botulinum toxin treatment.


CONCLUSIONS
These four patients with TN and HFS suggest a common aetiology for the two disorders, due either to central neuronal hyperactivity or to vascular compression of several cranial nerves. The beneficial effect of botulinum toxin in both disorders supports the idea of this toxin having a central mechanism of action that acts by controlling neuronal hyperactivity in the brain stem, as well as its peripheral action.
Boscá-Blasco
M E
ME
Servicio de Neurología, Hospital Universitari La Fe, 46009 Valencia, España. bosca_mar@gva.es
Burguera-Hernández
J A
JA
Roig-Morata
S
S
Martínez-Torres
I
I
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D003391:Cranial Nerves / Q000473:pathology / Q000503:physiopathology; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications; D009474:Neurons / Q000187:drug effects / Q000502:physiology; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D013981:Tic Disorders / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014277:Trigeminal Neuralgia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D019274:Botulinum Toxins, Type A