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Pathophysiology of hemifacial spasm

II. Lateral spread of the supraorbital nerve reflex

From the Department of Neurology, Neuromuscular Laboratory, University of Pittsburgh, Pittsburgh, PA.

The blink reflex was examined in 62 patients with hemifacial spasm. The latency and amplitude of the early (R-1) component of the orbicularis oculi response were increased as compared with the contralateral, unaffected side and controls, p < 0.001. On the affected side, all patients showed a synkinetic response in the mental muscle, and afteractivity and late-activity was observed after the reflex response. These findings indicate lateral spread of impulses to other fibers in the facial nerve (ephaptic transmission) and autoexcitation of fibers. The increased latency indicates a slowing of the nerve conduction in the facial nerve, in keeping with pathologic findings of focal demyelination.

Address correspondence and reprint requests to Dr. Nielsen. Department of Neurology, 322 Scaife Hall, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15261.

Presented in part at the thirty-fifth annual meeting of the American Academy of Neurology, San Diego, California, April 1983.

Accepted for publication July 19, 1983.

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