Quality of life in patients with hemifacial spasm after microvascular decompression and botulinum toxin therapy

To date, microvascular decompression (MVD) and botulinum therapy (BT) confirm own efficacy in the treatment of hemifacial spasm (HFS). Quality of life (QOL) suffers first of all in these patients. Therefore, the dynamics of QOL indicators determines postoperative outcomes. Various researchers have proposed specialized scales for assessing QoL in HPS patients (HFS-7, HFS-8, HFS-30). Objective. To analyze QOL in patients with HPS before and after MVD and BT including HFS-7 score and regression of HFS. Material and methods. We analyzed data of patients (n=80) divided into two groups: group I — MVD of the facial nerve (n=66), group II — BT (n=14). Mean age of patients was 52.4 (range 28—76) and 58.1 years (range 23—73), respectively. QOL was assessed using a questionnaire enrolling clinical and anamnestic data, as well as HFS-7 scale. Clinical severity of HFS and effect on daily activity were assessed using the Tan scale. We analyzed the results of MVD and BT considering clinical improvement (regression of spasm) and HFS-7 score. A four-level gradation of clinical regression of spasm was used. Results. Patients with mild course of disease and higher QOL prefer BT. In our sample, 3 (21%) patients from the 2nd group preferred surgery a year after BT, and 13 (20%) patients from the 1st group had previously undergone BT in other hospitals. Changes in HFS-7 score before and after treatment were significant in both groups (p<0.005, t-test). Spearman’s coefficient (R= –0.66) shows the correlation between clinical effect and HFS-7 score. Conclusion. MVD and BT significantly improve QOL in patients suffering from HFS. Patients with less severe hemispasm prefer BT, but conversion to surgery is possible as disease progresses. Both treatment methods should be available for HFS patients. Treatment outcomes should be assessed using specialized scales designed for HFS.