[Treatment of facial spasm with botulinum toxin].

Facialis spasmus (FS) is a chronic hyperkinesia primarily affecting patients in the 5th and 6th decades. Only muscles innervated by the facial nerve (FN) are involved. In the beginning there are only slight jerks, mostly in the region of the eyelid. In due course all facial muscles get involved. Spasms are worse when the patient is anxious, watching TV, working, driving and then restrict social activities. Because the etiology has not been known, a lot of methods of surgical and medical treatment were unsuccessful. Recently the cause has been clarified: FS is though to be caused by an irritation of this nerve by a blood vessel. The condition can be cured by an operation to separate the nerve and blood vessel. If an operation is thought to be inappropriate, treatment of FS may be with botulinum toxin (BT). BT is used in very small doses (nanograms), and is injected in the area of the muscle that is affected. This weakens the muscle and helps to prevent a spasm.