Introduction: Hemifacial spasm (HFS) is a debilitating disease that negatively impacts quality of life (QOL). Both botulinum toxin (BTX) and microvascular decompression (MVD) have proven to be effective in treating the symptoms of HFS. Our objective was to conduct a meta-analysis comparing outcomes of both treatments.
Methods: Literature searches were conducted using two sources: the National Library of Medicine’s PubMed search engine and the Cochrane Central Register of Controlled Trials. Searches included the concepts of hemifacial spasm, surgical therapy, drug therapy, clinical outcomes, quality of life outcomes, and quality of life assessment. Review articles, commentaries, case reports and articles not in English were excluded.
Results: Reviewed articles included 53 and 31 full texts reporting outcomes of HFS following treatment with MVD and BTX, respectively. Of patients undergoing MVD for HFS, 90% (95% CI 88-91, p<0.001, I2=0.91) experienced a complete recovery of symptoms while the mean peak improvement of symptoms following treatment with BTX was 77% (95% CI=74-81, p=0.380, I2=0.06). Patients undergoing MVD reported a greater improvement in QOL measurements as well as better post-intervention QOL scores in comparison with patients receiving BTX therapy. Patients receiving BTX were more likely to experience complications occurring in 16% (95% CI=8-25, p<0.001, I2=0.83) of all injections. All permanent complications following MVD had reported rates of 1% or less except for permanent hearing loss occurring at a rate of 3% (95% CI=2.0-4.0, p<0.001, I2=0.88).
Conclusions: Well-selected patients undergoing MVD may experience better response to treatment and, subsequently, better QOL as measured by disease specific QOL scales in comparison to patients receiving BTX.
Patient Care: Patients with hemifacial spasm often face difficulty in being referred for microvascular decompression. Physician education to the comparative risks and benefits to treatment of hemifacial spasm can greatly facilitate patient decision-making.
Learning Objectives: By the conclusion of this session, participants should: 1) Know the rates of efficacy and complications of botulinum toxin and microvascular decompression for the treatment of hemifacial spasm, 2) Discuss the risks and benefits of each treatment option that influence patient decisions, 3) Discuss the possible benefits to quality of life of patients who undergo microvascular decompression.