Hemifacial spasm in Singapore: clinical characteristics and patients ' perceptions.

Introduction: The aim of this study was to determine the clinical characteristics and patients' perception of hemifacial spasm (HFS) in Singapore. Materials and Methods: A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken. Results: Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8% of patients, and the orbicularis oculi was the first muscle to be affected in 86.1% of them. The majority (65%) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2 % of the patients, rendered 65 % of them depressed, affected the vision in 60.6% of them and compromised their work performance in 35.8%. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3%) tried traditional therapies (acupuncture or herbal medicine), while only 48.2% had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90% showed improvement at 1 month posttreatment. Conclusions: The clinical characteristics and patients' perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.