Objective: To determine clinical characteristics of non-motor symptoms in patients with primary hemifacial spasm (HFS) at a tertiary public center in Brazil.

Background: HFS is traditionally considered a motor disorder. However, growing evidence suggests that non-motor symptoms may significantly affect patients’ quality of life. Pain, psychiatric symptoms, and sleep disturbances remain underrecognized in this population and are the focus of this study.

Method: Cross-sectional analysis of patients with primary HFS followed at a tertiary public hospital. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Sleep quality and insomnia were evaluated with the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). HFS severity was measured using the HFS Score, which includes objective subscores for ocular and lower hemifacial involvement and a subjective disease burden scale ranging from 0–100.

Results: Eighty patients with primary HFS were evaluated. Fifty-seven (71.3%) were female, with mean age 65.4 ± 11.8 years. Median disease duration was 12.5 years (IQR 7–20) and median duration of botulinum toxin treatment was 10 years (IQR 5–18.8). Left-sided HFS occurred in 51 patients (63.7%). Median HFS objective scores were 5 (IQR 3–6) of a maximum of 8 for ocular symptoms and 4 (IQR 2–6) of 8 for lower hemifacial involvement. The median subjective disease burden score was 80 (IQR 20–100). Anxiety symptoms were present in 36 patients (45.0%) and depressive symptoms in 31 (38.8%) according to HADS. Facial pain was reported by 31 patients (38.8%), most frequently in the periorbital region (24/31; 77.4%), followed by maxillary (4/31; 12.9%), mandibular (2/31; 6.5%), and diffuse hemifacial pain (1/31; 3.2%). Headache occurred in 38 patients (47.5%), most commonly migraine without aura (16; 42.1%), followed by migraine with aura (10; 26.3%), episodic tension-type headache (8; 21.0%), and chronic tension-type headache (2; 5.2%). Insomnia (ISI ≥15) was identified in 7 patients (8.8%), while 35 (43.8%) had poor sleep quality (PSQI >5).

Conclusion: Non-motor symptoms are highly prevalent among patients with HFS, particularly anxiety, depression, pain, and sleep disturbances. These findings highlight the importance of a comprehensive clinical approach that extends beyond motor manifestations when managing patients with HFS.

References: Rudzińska M, Wójcik M, Szczudlik A. Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy. J Neural Transm (Vienna). 2010 Jun;117(6):765-72. doi: 10.1007/s00702-010-0416-5. Epub 2010 May 14. PMID: 20467763.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-in-hemifacial-spasm-a-cross-sectional-study-from-a-brazilian-public-tertiary-center/