Frequency and characterization of facial pain in individuals with hemifacial spasm in an outpatient clinic of a public tertiary center
Bibliographic record
Abstract
Background: Hemifacial spasm (HFS) is a movement disorder marked by involuntary facial muscle contractions, often due to a nearby blood vessel pressing on the facial nerve. Typically, HFS onset occurs between the fourth and sixth decades of life and has an annual incidence of 0.78 per 100,000, being considered a rare disorder. Botulinum toxin type A (BoNT-A) stands as the gold-standard therapy in the treatment of HFS. The presence of facial pain associated with HFS is commonly observed in clinical practice, although there is still little research on the subject. Objective: To characterize facial pain patterns in patients with HFS by evaluating the location, frequency, intensity, and duration of pain, as well as its relation to BoNT-A injections. Methods: A cross-sectional study was conducted with 53 HFS patients (F: 35, M: 18) at a public tertiary hospital over 6 months. The average age was 66.1 years (SD 12.2). Patients with cognitive impairment, BoNT-A use in the last three months, and other movement disorders were excluded. Data were collected using sociodemographic and structured facial pain questionnaires, the McGill Pain Questionnaire, and the HFS-Score for quality of life. Statistical analyses were performed using Epi Info software. Results: Among the 53 patients, 23 (43%) reported facial pain. The most common location was the periorbital region in 17 cases (65%), followed by maxillary region in 4 patients (15.3%), mandibular in 2 patients (7.6%), and auricular, whole hemiface and bilateral palpebra in 1 case (3.8%) each. All patients described pain ipsilaterally to the spasm side, and 1 patient described pain involving palpebral areas bilaterally. Spasms were present on the left side of the face in 33 (62%) patients. The average pain intensity was 6.1 on the Visual Analog Scale (VAS) (SD 2.1), with a mean frequency of 8.6 (SD 7.7) days/month and 2.3 (SD 2.3) episodes/day, lasting an average of 9.6 hours (SD 10). The average time to pain onset after HFS motor symptoms was 9.9 years (SD 9). Twenty patients reported that previous BoNT-A applications improved facial pain, while the remaining three reported no change. No patient reported a perception of worsening pain after BoNT-A injections. Although facial pain was frequently reported by the patients, no statistically significant difference was found between the severity of facial pain and the quality of life among individuals with HFS (p value 0,1993). The most common descriptors for the facial pain were: pulling (11 patients), itchy (10 patients), annoying (10 patients), miserable (9 patients), pinching (9 patients) Conclusion: This study highlights the need to investigate and treat facial pain in patients with hemifacial spasm, a rare and debilitating condition. Analyzing pain patterns and the efficacy of botulinum toxin treatment underscores the importance of tailored therapeutic approaches and guides future research.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".