Title:AChR+ Ocular Myasthenia and Facial Hemispasm: A Case Report of Unusual
Association and Botulinum Toxic Type A Safety and Efficacy
Volume: 18
Issue: 4
Author(s): Stefano Zoccolella*, Angelo Fabio Gigante and Salvatore Misceo
Affiliation:
- Neurology Unit, ASL Bari, San Paolo Hospital, Bari, Italy
Keywords:
Ocular, myastenia gravis, hemifacial spasm, botulinum, toxin, orbiculararis.
Abstract:
Introduction: Hemifacial spasm represents segmental myoclonus of muscles innervated
by the facial nerve, which is usually and successfully treated with botulinum toxin. Botulinum toxin
(BTX) acts as an acetylcholine release inhibitor at presynaptic cholinergic junctions and therefore
is considered contraindicated (or administrable with caution) in patients with neuromuscular
disorders like Myasthenia Gravis (MG). Moreover, to date, the association of hemifacial spasm and
ocular MG is extremely rare and only a few cases have been described.
Case Presentation: We report the case of a 73 years old man with a 3-year history of ocular MG
who developed a left hemifacial spasm. The patient underwent hemispasm, treatment with BTX
type A (abobotulinum toxin-A, total dose of 50 IU) that resulted in safe and successful 6 months
re-evaluation.
Conclusion: Our results suggest that in selected cases with concomitant MG and conditions characterized
by orbicularis oculi spasms or hemispasm, BTX therapy may not be contraindicated and
could be given at longer intervals due to prolonged effects.
