Abstract Details

Title Hemi Masticatory Spasm: Series of 8 Cases

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-052

Objective To report retrospective review of eight cases of hemimasticatory spasm (HMS) supported by electrophysiological and clinical findings.

Background HMS is rare movement disorder affecting muscles of mastication due to dysfunction of motor branch of trigeminal nerve and is characterised by painful spasm of masticatory muscles. Micro vascular compression leading to focal demyelination of motor branch of trigeminal nerve is the most speculated mechanism of HMS. Treatment options range from medical to surgical approaches but botulinm toxin has become preferred treatment now.

Design/Methods We enrolled a total of 8 patients with HMS (5 males and 3 females) over a period of 4 years (2013-2017). Mean age of these patients was 35 ± 7.75 years (range: 23-45 years) with duration of masticatory spasms for 2 - 9 years.

Results All patients presented with unilateral spasms involving either masseter or temporalis muscles or both, without any apparent cause. Associated muscle hypertrophy was seen in 3 cases and FHA was seen in 5 cases. Associated Lichen Sclerosus et Atrophicus with segmental morphea was seen in 1 patient and localised scleroderma of face seen in 2 patients. Surface electromyography showed spontaneous irregular bursts of high frequency motor unit potentials arising from involved muscles during spasm. Masseter inhibitory reflex showed loss of inhibition in form of absent silent period during spasms.

All 8 patients initially received phenytoin (250-300mg/day) without any sustainable effect. However both pain and spasms showed excellent response to local Onabotulinumtoxin-A injection in all patients. All patients reported at least 70-80% improvement of pain and spasms at last follow up.

Conclusions In this paper we highlight the delay in diagnosis of HMS due to rarity, long course of illness, association with FHA, “Lichen Sclerosus et Atrophicus” and scleroderma / morphea. Considering the favourable outcome to botulinum toxins surgical treatment can be avoided or delayed in majority except secondary cases.

Authors/Disclosures
Divya Madathiparambil (Department of Neurology) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Mamta B. Singh, MD, MBBS, DM, FAAN (All India Institute of Medical Sciences)	Dr. Singh has nothing to disclose.

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