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Botulinum toxin (BTX) is the medical therapy of choice in hemifacial spasm (HFS). However, in some patients, its therapeutic effect is insufficient.
Case reports.
Patient 1.
A 64-year-old man with a 10-year history of left-sided HFS was treated with BTX over a period of 6 years with good results. However, in the last 2 years the spasms were never sufficiently relieved by BTX. The patient felt significantly impaired, but declined to undergo neurosurgical intervention. The EDB test showed a decrease in the CMAP amplitude of 60%. Without changing the BTX regime, pregabalin (initially 75 mg/day increased every 5 days by 75 mg to 150 mg twice daily) was added for a 1-month trial period in the absence of adverse effects. The HFS subsided gradually. After discontinuation of the drug at the end of the trial period, the symptoms recurred after <4 weeks. Rechallenge with pregabalin alone at a dosage of 300 mg/day over 4 weeks improved HFS but did …
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