HEMIFACIAL SPASM

HEMIFACIAL SPASM

What is hemifacial spasm?

Hemifacial spasm (HFS) refers to sudden episodic involuntary contractions of muscles on one side of the face.

                                                                                   (Swedish)

Who suffer from hemifacial spasm?

Hemifacial spasm occurs in people all over the world. It occurs more commonly in people aged 40-60 years. It affects both men and women, however, slightly more common in women.

What causes hemifacial spasm?

1.     In most people, there is no specific cause for hemifacial spasm, when it is referred to as idiopathic.

2.     In some people, there is compression of facial nerve (that supplies facial muscles) by a blood vessel.

3.     In some others, the compression could be due to tumors, aneurysms (abnormal balloon-like dilatation of the vessel wall), etc.

4.     Medical problems of brain such as infarct (blood clot in brain) or multiple sclerosis can also cause HFS.

What investigations are usually needed?

A detailed clinical examination needs to be performed by neurologist. This would confirm the diagnosis. The diagnosis is based on clinical examination and no test is needed for that. However, MRI with MR Angiogram brain is needed to exclude secondary causes (as listed in points 2-4 above).

How is hemifacial spasm treated?

1.     Botulinum toxin (botox) is the treatment of choice. Botox injections are given in the affected muscles. The benefit is seen within a few days and the effect may last upto 6 months.

2.     Those who refuse botox or cannot afford it can be treated with medications such as carbamazepine, clonazepam or baclofen tablets.

3.     Those who do not respond to botox or medicines can be treated with microvascular decompression (MVD) surgery.

Can there be a serious complication due to hemifacial spasm?

If all secondary causes have been excluded with MRI of brain, we do not expect any serious complications. However, frequent closure of eyes can be a hindrance for safe driving. Moreover, it may lead to awkward situations, especially in front of people of opposite gender.

What is the long-term outcome of hemifacial spasm?

Both botox and MVD surgery are effective and safe treatments, leading to excellent long-term outcome.

DR SUDHIR KUMAR MD DM

CONSULTANT NEUROLOGIST

Apollo Hospitals, Hyderabad

drsudhirkumar@yahoo.com

https://www.facebook.com/bestneurologist/

04023607777

ACADEMIC MEETINGS, CONFERENCES, CME- DR SUDHIR KUMAR

PARTICIPATION IN ACADEMIC MEETINGS, CONFERENCES, CMEs 

Dr Sudhir Kumar MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

drsudhirkumar@yahoo.com

Participation in academic meetings is an important method of learning from experts and imparting knowledge to colleagues and peers. These meetings provide platforms to meet colleagues, learn and share from each other.

2019

January 12th 2019: CASE-BASED APPROACH TO VERTIGO MANAGEMENT

Panelist, along with guest speak Prof Michael Strupp (Germany)

January 16th, 2019: Brighter outcomes; Advancing epilepsy management (Guest speaker: Prof Pavel Klein, Washington DC)

Moderator for a panel discussion on "Balancing seizure control with better quality of life" 

2018

1. Obstetric Medicine update 2018 (Hyderabad): Delivered a lecture "When stroke strikes pregnancy"

2. Neuro Critical Care Update 2018 (Hyderabad): Organised the second Neuro critical Care update 2018 on 16th December 2018 at Apollo Hospitals, Hyderabad. There were ten lectures taken by experts and it was attended by about 70 doctors. I spoke on the topic "Current management of cerebral venous sinus thrombosis)". 

3. EPILEPSY EXPERT GROUP MEETING (13th December 2018, Hyderabad). In this meeting, I spoke on the topic "Zonisamide as a monotherapy in partial onset seizures."

4. STROKE ACADEMY MASTERCLASS (8th-9th December, 2018, Mumbai)

I was a faculty in this meeting, where I spoke on the topic "Quality monitoring in stroke care".

PUBLICATIONS IN PEER-REVIEWED JOURNALS-DR SUDHIR KUMAR

PUBLICATIONS IN PEER-REVIEWED JOURNALS

Dr SUDHIR KUMAR MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

drsudhrikumar@yahoo.com

Publications are an important means of disseminating knowledge. Many scientific journals are available online, making the access easier. In the initial part of my career, I was not keen on publishing, as I thought, the main duty of a doctor is to treat sick patients. As I was a faculty in a teaching college (CMC Vellore) during 2001-2004, teaching postgraduates was an added responsibility, leaving less time for writing and publishing. However, Prof mathew Alexander, my teacher in Neurology at CMC Vellore, stressed on the importance of publishing. This resulted in multiple publications in peer-reviewed journals. These are listed below:

2001

1. V Markandeyulu, T P Joseph, T Solomon, J Jacob, S Kumar, C Gnanamuthu. Stiff-man syndrome in childhood. J R Soc Med. 2001; 94: 296-7. 

2003

2. Sudhir Kumar. Adverse effects due to poor patient understanding of the antiepileptic medication prescriptions. Indian Pediatr 2003; 40: 801-2

3. Sudhir Kumar. Inappropriate prescription of corticosteroids in respiratory infections. Indian Pediatr 2003; 40:1111.

4. Sudhir Kumar. Overdiagnosis of cerebral malaria in patients admitted with neurological dysfunction. Q J Med 2003; 96: 688.

5. Sudhir Kumar. Medically unexplained symptoms. J R Soc Med 2003; 96: 422.

6. Sudhir Kumar. Representation of South Asian people in randomised trials: study results are interesting but not final word. Br Med J. 2003; 327: 394. 

7. Sudhir Kumar. Management of shock in children with severe P. falciparum malaria. Q J Med2003; 96: 778.

8. Kumar S, Alexander M, Markandeyulu V, Gnanamuthu C. Guillain-Barre syndrome presenting in the anti-HIV seroconversion period. Neurol India 2003; 51: 559.

9. Sudhir Kumar. Nimesulide: How safe is it? Natl Med J India 2003; 16: 233-4.

10. Sudhir Kumar. Predicting long-term morbidity in Indian patients with ischemic stroke. Neurol India. 2003; 51:285-6. 

11. Sudhir Kumar. Steroid-induced myopathy following a single oral dose of prednisolone. Neurol India. 2003; 51: 554-6.

12. Sudhir Kumar. Prophylaxis of depression in older people. Br J Psychiatry. 2003; 183:365.

13. Sudhir Kumar. Management of ocular myasthenia gravis coexisting with thyroid ophthalmopathy. Neurol India. 2003; 51:283-4.

14. Sudhir Kumar. Distal asymmetric spinal muscular atrophy involving upper limbs. Indian Pediatr2003; 40:1211-2

15. Sudhir Kumar. Health of indigenous people- health of aboriginal communities can be improved by innovative methods. Br Med J. 2003; 327: 988

16. Sudhir Kumar. Differentiating traumatic neuritis from poliomyelitis. Natl Med J India. 2003; 16: 232-3.

17. Sudhir Kumar. Anticonvulsant-hypersensitivity syndrome in a child. Neurol India. 2003; 51: 427

18. Sudhir Kumar. Prognosis in children with head injury: Inaccuracies in the analysis. Neurol India 2003; 51: 427-8.

19. Sudhir Kumar. Delayed diagnosis of myasthenia gravis due to prior empirical therapy with corticosteroids. Annals of Indian Academy of Neurology 2003; 6:171-2.

20. S Kumar, Hannah V, M Alexander, C Gnanamuthu. Rapidly progressive dementia as a presenting feature of acute disseminated encephalomyelitis (ADEM). Annals of Indian Academy of Neurology 2003; 6:167-70.

21. Sudhir Kumar. Mechanical ventilation in Guillain-Barre syndrome. Neurol India. 2003; 51:559-60.

22. Sudhir Kumar. Factors affecting functional recovery in ischemic stroke. Neurol India 2003; 51:561.

2004

23. Sudhir Kumar. Recurrent seizures: An unusual manifestation of vitamin B12 deficiency. Neurol India 2004; 52:122-3.

24. Sudhir Kumar. Overweight and obesity in children. Indian Pediatr 2004; 41:200.

25. Sudhir Kumar. Missed and delayed diagnosis of neonatal meningitis. Indian Pediatr 2004; 41:959

26. Sudhir Kumar. Vitamin B12 deficiency presenting with an acute reversible extrapyramidal syndrome. Neurol India. 2004; 52:507-9.

27. Sudhir Kumar. Improving clinical course in congenital hypomyelinating neuropathy. Indian Pediatr 2004; 41:1171.

28. Sudhir Kumar. Artemether in children with severe malaria. Indian Pediatr 2004; 41:520-1.

29. Sudhir Kumar. Unusual cause of recurrent flaccid paralysis in a child. Neurol India. 2004; 52:126.

30. Sudhir Kumar. Clinical characteristics of organophosphate-induced delayed polyneuropathy.Neurol India. 2004; 52:128-9.

31. Sudhir Kumar. Nadroparin in acute ischemic stroke. Neurol India. 2004; 52:273-4.

32. Kumar S, Alexander M, Joseph M, Gnanamuthu C. Symmetrical peripheral gangrene: association with adrenaline administration. Critical Care Asia 2004;2(1):19-21

33. Sudhir Kumar. Conversion disorder in childhood. J R Soc Med. 2004; 97:98

34. S Kumar, M. Alexander, C. Gnanamuthu. Recent experience with Rett Syndrome at a tertiary care center. Neurol India 2004; 52:494-5.

35. S Kumar, N. Kesavalu, E. Chandy. Periodic lateralized epileptiform discharges in a child with solitary cysticercus granuloma. Neurol India 2004; 52:523-4.

36. S Kumar, M. Alexander, C. Gnanamuthu. Refractory status epilepticus due to cerebral venous thrombosis during late pregnancy with successful outcome. Annals of Indian Academy of Neurology.2004; 7:305-8.

37. Sudhir Kumar. A trial of antiparasitic treatment for cerebral cysticercosis.N Engl J Med 2004; 350:1686.

38. Sudhir Kumar. Epidemiological study of neurological disorders. J Indian Med Assoc. 2004; 74:108.

39. Sudhir Kumar. When to start drug therapy in epilepsy. J R Soc Med. 2004; 97:208.

40. Sudhir Kumar. Withdrawal of ventilatory support in the intensive care unit. Natl Med J India 2004; 17:28-9.

41. Sudhir Kumar. Acute reversible mania as a presenting feature of vitamin B12 deficiency. Annals of Indian Academy of Neurology. 2004; 7:309-11.

42. Sudhir Kumar. Epilepsia partialis continua stopped by insulin. J R Soc Med 2004; 97:332-3.

43. Sudhir Kumar. Psychogenic non-epileptic seizures. Indian Pediatr 2004; 41:1050-2.

44. Sudhir Kumar. Paradoxical worsening of neurological status after starting d-penicillamine therapy in a patient with Wilson's disease. Annals of Indian Academy of Neurology 2004; 7:401-402.

45. Sudhir Kumar. Why do doctors make errors? Natl Med J India 2004; 17(1):53-4.

46. Sudhir Kumar. Calvarial thickening and cerebellar atrophy following chronic phenytoin usage.Annals of Indian Academy of Neurology 2004; 7:403.

47. Sudhir Kumar. A patient's opinion is often valuable. J Postgrad Med 2004; 50:216.

48. Sudhir Kumar. Memantine:Pharmacological properties and clinical uses. Neurol India2004:52:307-9.

49. Kumar S, Kumar PR. Mimetic facial paresis. Annals of Indian Academy of Neurology. 2004; 7:405.

50. Kumar S, Kumar PR. Skin branding. J Postgrad Med 2004; 50:204.

51. S Kumar, M Alexander, C Gnanamuthu. Manual (low-volume) plasmapheresis: an effective and safe therapeutic procedure in acute neurological illnesses. Annals of Indian Academy of Neurology 2004; 7:439-40.

52. Sudhir Kumar. Bisphosphonate therapy for polyostotic fibrous dysplasia. Indian Pediatr. 2004; 41:1069-70.

53. S Kumar, M Alexander, C Gnanamuthu. Heterogeneity in clinical presentation of acute disseminated encephalomyelitis. Neurol India. 2004;52:518-9.

54. S Kumar, S Aaron. Internuclear ophthalmoplegia as the sole presenting symptom of inflammatory demyelinating lesion of the brainstem. Neurol India 2004; 52:517-8.

55. Sudhir Kumar. Rheumatological manifestations of leprosy. Indian Journal of Dermatology, Venereology and Leprology. 2004; 70:250.

56. Sudhir Kumar. Dermatological findings in chronic alcoholics. Indian Journal of Dermatology, Venereology and Leprology. 2004; 70:317.

57. S Kumar, Rashmi. Psychosomatic illness among patients attending medical outpatient department. J Indian Med Assoc. 2004; 102:330-1.

58. S Kumar, S Nair, M Alexander. Carcinomatous meningitis occurring prior to the diagnosis of large cell neuroendocrine carcinoma of the uterine cervix. J Postgrad Med. 2004;50:311-2.

59. S Kumar, P Ravi Kumar. Multi-segmental Neurofibromatosis. Indian J Dermatol Venereol Leprol2004; 70:360-2.

60. Sudhir Kumar. Differentiating paralytic rabies from post antirabies vaccine polyradiculoneuropathy. Neurol India 2004; 52:270.

61. Sudhir Kumar. Oral glucose tolerance test in patients with unexplained peripheral neuropathy. Natl Med J India 2004; 17:206.

62. Sudhir Kumar. Nimodipine in severe head injury. Neurol India 2004;52:392-3

63. Sudhir Kumar. Communications skills: is there a need for training? Natl Med J India 2004; 17:280-1.

64. Sudhir Kumar. Pituitary in psychosis. Br J Psychiatry 2004; 185:437-8.

65. Kumar S, Jacob J. Variability in the extent of sensory deficit after sural nerve biopsy. Neurol India 2004; 52:436-8.

66. Kumar S. An uncommon cause of shoulder pain in acute ischaemic stroke. J Indian Med Assoc 2004; 102:594-6.

2005

67. Singh S, Kumar S, Joseph M, Gnanamuthu C, Alexander M. Cerebral venous sinus thrombosis presenting as subdural haematoma. Australasian Radiology 2005;49:101-3.

68. Sudhir Kumar. Factors leading to underdiagnosis or under-reporting of AIDS. Trop doct. 2005; 35:124.

69. S Kumar, J Vijayan, J Jacob, S Aaron, M Joseph, M Alexander, C Gnanamuthu. Cervical spine injuries in 64 attempted suicidal hangings in India. Trop Doct 2005;35:198-200.

70. Sudhir Kumar. Factors precipitating breakthrough seizures in well-controlled epilepsy. Indian Pediatr 2005; 42:182-3.

71. Sudhir Kumar. Severe autonomic dysfunction as a presenting feature of Wilson's disease. J Postgrad Med 2005; 51:75-6.

72. Sudhir Kumar. Wilson's disease presenting as status epilepticus. Indian Pediatr. 2005; 42:492-3.

73. Sudhir Kumar. Tongue biting and epilepsy. Indian Pediatr 2005; 42:296.

74. Sudhir Kumar. Painful mononeuritis multiplex in idiopathic thrombocytopenic purpura. Indian Pediatr 2005; 42:621-2.

75. Sudhir Kumar, Rashmi. Branding: A harmful practice. Indian Pediatr 2005;42:721.

76. Sudhir Kumar. Valproate-induced bleeding: report of two cases and review of literature. Indian Pediatr 2005; 42:833-4.

77. Sudhir Kumar. Neurofibromatosis type 1 manifesting with Tourette syndrome. Neurol India2005;53:361-2.

78. Sudhir Kumar. Punding in Parkinson's disease related to high-dose levodopa therapy. Neurol India 2005;53:362.

79. Sudhir Kumar. Thyrotoxic periodic paralysis. Thyroid Research & Practice 2005; 2: 12-8.

80. Sudhir Kumar. Calcified vertebral artery and dense basilar artery sign in a patient with basilar territory infarction. Neurol India 2005;53:125.

81. Aaron S, Kumar S, Vijayan J, Jacob J, Alexander M, Gnanamuthu C. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurol India 2005;53:55-8.

82. Kumar S, Prabhakar S. Guillain-Barre syndrome occurring in the course of Dengue fever. Neurol India 2005;53:250-1.

83. Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C, Cherian A.Behaviour problems in children and adolescents with seizure disorder: associations and risk factors. Seizure:European Journal of Epilepsy 2005;14:190-7.

84. Garikapati R, Kumar S, Prabhakar S. ATL in refractory epilepsy with normal MRI-volumetric criteria? Epilepsia 2005; 46:600.

85. Kumar S, Chandy E. Asymmetric depression of amplitude in electroencephalography leading to a diagnosis of ipsilateral cerebral tumor. Annals of Indian Academy of Neurology 2005;8:33-5.

86. S Kumar, G Rajshekher, S Prabhakar. Management of myasthenic crisis. Neurol India 2005;53:241.

87. S Kumar. Preventive therapy of migraine. Neurol India 2005;53:243.

88. S Kumar, G Rajshekher, S Prabhakar. Positron emission tomography in neurological diseases. Neurol India 2005;53:149-55.

89. S Kumar. Recombinant activated Factor VII for acute intracerebral hemorrhage. Indian Journal of Critical Care Medicine 2005;9:11-13.

90. S Kumar, P Ravi Kumar, N Manasseh. Massive pneumocephalus and meningitis following spine instrumentation. Annals of Indian Academy of Neurology 2005;8:55-7.

91. S Kumar. Guillain-Barre syndrome in leprosy patients. Indian J Lepr. 2005;77:162-8.

92. S Kumar. Cranial nerve involvement in leprosy. Indian J Lepr. 2005;77:177-8.

93. S Kumar, G Rajshekher, S Prabhakar. Dense basilar artery sign preceding basilar artery territory infarction. Annals of Ind Acad Neurol 2005;8:321-2.

2006

94. S Kumar, Badrinath HR. Early recombinant factor VIIa therapy in acute intracerebral hemorrhage: Promising approach. Neurol India 2006;54:24-7.

95. S Kumar. Plasmapheresis in acute disseminated encephalomyelitis. Indian Pediatr2006;43:77-8.

96. SS Datta, S Kumar. Hypomania as an aura in migraine: case report. Neurol India 2006;54:205-6.

97. SS Datta, S Kumar. Clozapine-responsive cluster headache. Neurol India 2006;54:200-1.

98. SS Datta, R Jacob, S Kumar, S Jeyabalan. A case of subacute sclerosing panencephalitis presenting as depression. Acta Neuropsychiatrica 2006; 18: 55-7.

99. SS Datta, TS Premkumar, S Fielding, S Chandy, S Kumar, JM Eagles, A Cherian. Impact of pediatric epilepsy on Indian families. Epilepsy and Behavior. 2006;9:145-51.

100. S Kumar, M Alexander, C Gnanamuthu. Cranial nerve involvement in patients with leprous neuropathy. Neurol India 2006;54:283-5.

2007

101. S Kumar. Expansion of traumatic intracerebral hemorrhage: treatment implications with recombinant Factor VIIa. Neurol India 2007;55:81.

102. S Kumar. Basilar artery thrombosis. Annals Ind Acad Neurol 2007;10;61-2

103. S Kumar, G Rajshekher, S Prabhakar. Isolated complete third nerve palsy due to midbrain hemorrhage: clinico-radiological correlation. Annals Ind Acad Neurol 2007;10:187-8.

104. S Kumar. Thrombolysis with tissue plasminogen activator: Protocol violation is not an option. Neurol India 2007;55:174.

105. S Kumar. Pseudoxanthoma elasticum and cerebral ischemic stroke. Indian J Dermatol Venereol Leprol 2007; 73: 433-4.

2008

106. S Kumar, G Sandhya, R Reddy, G Rajshekher, S Prabhakar. Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide? Neurology 2008; 70:160.

107. G Rajshekher, S Kumar, S Prabhakar. Reversible electrophysiological abnormalities in hypokalemic periodic paralysis. Indian Pediatrics 2008;45:54-5.

108. S Kumar, G Rajshekher, S Prabhakar. Isolated bilateral ptosis as the presentation of midbrain tuberculoma. Neurol India 2008; 56:212-3.

109. S Kumar, G Rajshekher, S Prabhakar. Platelet glycoprotein IIb/IIIa inhibitors in acute ischemic stroke. Neurol India 2008;56:399-404.

2009

110. S Kumar, R Reddy, S Prabhakar. Contralateral diaphragmatic palsy in acute stroke: An interesting observation. Ind J Crit Care Med 2009; 13:28-30.

2010

111. S kumar, G Rajshekher, C R Reddy, J Venkateswarlu, S Prabhakar. Intra-sinus thrombolysis in cerebral venous sinus thrombosis: single center experience in 19 cases. Neurol India 2010;58:225-9.

112. R Lath, S Kumar, R Reddy, G R Boola, A Ray, S Prabhakar, A Ranjan. Decompressive surgery for severe cerebral venous sinus thrombosis. Neurol India 2010;58:392-7.

2012

113. S Bhuvaneshwari, Sujith Chandy, Sudhir Kumar. A prospective, double-blinded, crossover study to determine the equivalence of the serum levels and the peak level toxicity of diphenylhydantoin (Eptoin ER). Journal of Clinical and Diagnostic Research. 2012;6:783-786.

2013

114. Varghese GM, Mathew A, Kumar Sudhir, Abraham OC, Trowbridge P, Mathai Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features. Neurol India 2013;61:17-20

115. Sudhir Kumar, Chenna Rajesh Reddy, Subhashini Prabhakar. Striatal toe. Ann Ind Acad Neurol. 2013;16:304-5

116. S Bhuvaneshwari, Sujith Chandy, Sudhir Kumar. Equivalence of the steady state concentrations of two dosage regimens of phenytoin using computer optimisation programme OPT6. International Journal of Pharmaceuticals and Biological Archives.2013;4:899-902. 

2016

117. Kumar S. Hypertension and ischemic stroke. Hypertens J. 2016;2:39-43.

118. Kumar S, Reddy CR, Prabhakar S. Bilateral putaminal necrosis in a comatose patient with metabolic acidosis. Indian J Crit Care Med. 2016;20:745-8.

2017

119. Kumar S. Hypertension and hemorrhagic stroke. Hypertens J. 2017; 3:89-93.

2018

120. Kumar S, Rohatgi A, Chaudhari H, Thakor P. Evolving landscapes of multiple sclerosis in India: Challenges in the management. Ann Ind Acad Neurol 2018;21:107-15.

2019

121. Ramesh V, Narreddy S, Barigala R, Kumar Chennamchetty V, Kumar S, Rao J, Nanda S, Varahala S. 1374. Diagnostic Utility of Whole Body Positron Emission Tomography-Computerized Tomography (PET-CT) in Patients with Suspected Central Nervous System Tuberculosis: A Retrospective, Descriptive Study. Open Forum Infect Dis. 2019 Oct 23;6(Suppl 2):S498–S499. doi: 10.1093/ofid/ofz360.1238. PMCID: PMC6808727.

Books, Chapters, monographs

1. Elizabeth Chandy, Sudhir Kumar. Atlas of Electroencephalography in Adult & Child. Mattethra Group Publications, Cochin, India, 2004.

2. Sudhir Kumar. Cerebrovascular diseases in the elderly. In Progressive General Practice- Geriatrics issue. Ed, Alka Ganesh. CME series of Christian Medical College, Vellore, India, 2002.

3. Soumitra S. Datta, Sudhir Kumar, K.S. Jacob. Clinical approach to dementia. In Textbook of Psychiatry, Bangalore.

4. Sudhir Kumar. Muscular dystrophies in children and adolescents. In Update in Pediatrics Volume 1, 1st edition, Mathur & Mathur Eds, 2005.

5. Sudhir Kumar. Neonatal Meningitis. In Textbook of Neonatal Emergencies. Ed Prof Suraj Gupte, Peepee Publishers and Distributors, New Delhi, 2006

6. Sudhir Kumar, Subhash Kaul. Approach to a patient with hemiplegia and monoplegia. Progress in Medicine 2017. Published by Association of Physicians of India (API) (Can be accessed at http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf)