Aurelian Anghelescu, Cristina Gorgan, George Petcu and Gelu Onose
Background: Hemifacial spasm (HFS) is a rare entity, characterized by alternating involuntary twitching (clonic or tonic contractions) of the facial muscles on one side of the face. In most cases the pathophysiological mechanism is represented by a neurovascular conflict.
Methods and findings: The actual case refers to a 62 years old Caucasian woman, with a typical progressive left side HFS, manifested at the age of 55. She was admitted twice (in November 2015 and February 2016) in the rehabilitation department, and investigated for an optimal therapeutic approach. Magnetic resonance angiography (MRA) revealed a mechanical neurovascular conflict, inflicted by an ipsilateral dolichoectatic, compressive vertebral artery. The patient categorically refused the conventional standard therapies (the functional neurolysis with botulinum toxin injections, or the microvascular surgical decompression alternative). She was treated in a conservative manner, using iontophoresis with potassium iodide (KI) applied to the twitched hemiface, for 10 days, in two therapeutic sequences. After the second treatment session, the patient noticed a 47% global reduction of her disturbances, reflected by the self-assessment questionnaires scores.
Conclusion: Iontophoresis with KI is an inedited, conservative treatment applied in a typical form of HFS (with vascular compressive etiology), indicated as a therapeutic palliative alternative, to a patient who refused the conventional treatment methodology. It is a cheap procedure, painless, without adverse reactions, repeatable, controllable. The patient had a good compliance and therapeutic satisfactions, although symptoms alleviation was partial and temporary (as long as the trigger persisted).
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