Tan E K, Chan L L
Department of Neurology, Singapore General Hospital, Singapore.
Acta Neurol Scand. 2006 Jul;114(1):59-62. doi: 10.1111/j.1600-0404.2006.00650.x.
Hemifacial spasm (HFS) frequently affects middle aged individuals and the clinical features and etiology have been well reported. However, there is limited data on the exact pathogenesis in young-onset HFS. If age is a major determinant of the etiology or influences the presentation of HFS, there may be clinical differences between the young and elderly HFS patients.
We determined the prevalence, clinical and imaging features of young-onset HFS (age of onset<or=30 years) in a tertiary referral center. These data were compared with old onset (age of onset>or=65 years) HFS patients.
We examined consecutive patients clinically diagnosed with HFS in a tertiary referral center. The clinical (demographics, clinical presentation, severity of HFS, associated medical conditions and other variables) and imaging findings of young onset patients and old onset patients were tabulated and compared.
Amongst 230 consecutive HFS patients, 15 (6.5%) were young-onset HFS and 50 (21.7%) were old-onset HFS. In the young-onset HFS, the mean age of onset of symptoms was 26.5+/-6.5 (6-30) years, with 80% women and 75.0% of young onset HFS having neurovascular compression (NVC) of the root exit zone (REZ) of the facial nerve on the ipsilateral side; 86.7% had initial onset of twitching in the upper eyelids that later progressed to the lower facial muscles. While the prevalence of hypertension, diabetes mellitus and other associated vascular disorders in late onset HFS was higher than in young onset groups, the clinical features and frequency of NVC of the facial REZ between the two groups were similar.
We demonstrated a 6.5% frequency of young-onset HFS in our cohort of HFS and their clinical presentation was similar to the old onset patients. Genetic, anatomic or other unidentified factors may contribute to NVC in young-onset HFS.
半面痉挛（HFS）常影响中年个体，其临床特征和病因已有充分报道。然而，关于青年起病型HFS的确切发病机制的数据有限。如果年龄是病因的主要决定因素或影响HFS的表现，那么青年和老年HFS患者之间可能存在临床差异。
我们在一家三级转诊中心确定了青年起病型HFS（发病年龄≤30岁）的患病率、临床和影像学特征。将这些数据与老年起病型（发病年龄≥65岁）HFS患者进行比较。
我们检查了在一家三级转诊中心临床诊断为HFS的连续患者。将青年起病型患者和老年起病型患者的临床（人口统计学、临床表现、HFS严重程度、相关内科疾病及其他变量）和影像学检查结果列表并进行比较。
在230例连续的HFS患者中，15例（6.5%）为青年起病型HFS，50例（21.7%）为老年起病型HFS。在青年起病型HFS中，症状的平均发病年龄为26.5±6.5（6 - 30）岁，80%为女性，75.0%的青年起病型HFS患者同侧面神经根部出口区（REZ）存在神经血管压迫（NVC）；86.7%最初表现为上睑抽搐，随后进展至下面部肌肉。虽然老年起病型HFS中高血压、糖尿病和其他相关血管疾病的患病率高于青年起病型组，但两组之间面神经REZ的临床特征和NVC频率相似。
我们在HFS队列中证明青年起病型HFS的发生率为6.5%，其临床表现与老年起病型患者相似。遗传、解剖或其他未明确的因素可能导致青年起病型HFS中的NVC。
