Summary
For many years carbamazepine and baclofen have been the only pharmacological treatments for hemifacial spasm (HFS), but their efficacy is low and they have noticeable side-effects.
Local injections of botulinum toxin (Bo-Tx) is now the reference treatment for HFS. This toxin binds selectively to cholinergic presynaptic endings of the peripheral nervous system (motor endplates and postganglionic parasympathetic fibers), translocates into presynaptic cytosol, and inhibits vesicular release of acetylcholine, resulting in muscular paralysis. Bo-Tx is very effective in treating HFS but is not truly appropriated to its pathophysiology. In addition, it may have adverse side-effects due to spreading beyond its target, and it may induce plastic changes in the peripheral nervous system.
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Ollat, H. (1997). Pharmacology of hemifacial spasm. In: Sindou, M., Keravel, Y., Møller, A.R. (eds) Hemifacial Spasm. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6829-5_15
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DOI: https://doi.org/10.1007/978-3-7091-6829-5_15
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