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Use of botulinum toxin injections to treat peripheral stimulator induced facial muscle twitching: a case report.

Trentman TL, Maloney JA, Wie CS, Rebecca AM, Rosenfeld DM - Springerplus (2015)

Bottom Line: Peripheral nerve/field stimulation may be an effective option for refractory cases, but direct muscle stimulation with facial twitching may result.She received two subsequent treatments of botulinum toxin injections at 5-month intervals with similar results.Botulinum toxin injections may be an effective treatment modality when stimulation techniques provide pain relief but also causes muscle twitching.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA.

ABSTRACT

Background: Facial pain can be a management challenge. Peripheral nerve/field stimulation may be an effective option for refractory cases, but direct muscle stimulation with facial twitching may result. Botulinum toxin injections have been used for blepharospasm and may be effective when facial stimulation results in unacceptable facial muscle twitching due to peripheral stimulation.

Case presentation: A 53-year old female suffered with chronic, refractory facial pain and migraines. Her facial pain began after a root canal of a left upper molar. She was trialed and then permanently implanted with a 1 × 8 sub-compact percutaneous stimulator lead, resulting in improved pain control and reduced medication use. However, she experienced blepharospasm whenever the amplitude was above 2.75 A. Therefore, she was treated with botulinum toxin injections into her bilateral cheek, face, temple and occiput. This treatment provided excellent relief of the facial spasms, allowing her to use her stimulator at high amplitudes, and thereby maximizing her pain relief. She received two subsequent treatments of botulinum toxin injections at 5-month intervals with similar results.

Conclusion: Peripheral nerve/field stimulation is being used for headaches and facial pain. An undesirable side effect of this emerging therapy is direct muscle stimulation. Botulinum toxin injections may be an effective treatment modality when stimulation techniques provide pain relief but also causes muscle twitching.

No MeSH data available.


Related in: MedlinePlus

Lateral skull film demonstrating the location of the peripheral stimulation lead in relation to the left upper molars
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Fig1: Lateral skull film demonstrating the location of the peripheral stimulation lead in relation to the left upper molars

Mentions: After a successful percutaneous trial of facial stimulation the patient was taken to the operating room for permanent implant. After induction of general anesthesia, a 14-gauge Tuohy needle was inserted subcutaneously through an incision on the left cheek. Under fluoroscopic guidance, a 1 × 8 sub-compact percutaneous lead (Medtronic, Minneapolis, MN, USA) was inserted over the left maxilla, with care to place the distal 2 contact points next to the upper molars. Several adjustments to the lead were necessary before a position was found where no muscle twitching was observed upon testing, even at high amplitude and low frequency stimulation (e.g. 10 A, 2 Hz), see Fig. 1.Fig. 1


Use of botulinum toxin injections to treat peripheral stimulator induced facial muscle twitching: a case report.

Trentman TL, Maloney JA, Wie CS, Rebecca AM, Rosenfeld DM - Springerplus (2015)

Lateral skull film demonstrating the location of the peripheral stimulation lead in relation to the left upper molars
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4633430&req=5

Fig1: Lateral skull film demonstrating the location of the peripheral stimulation lead in relation to the left upper molars
Mentions: After a successful percutaneous trial of facial stimulation the patient was taken to the operating room for permanent implant. After induction of general anesthesia, a 14-gauge Tuohy needle was inserted subcutaneously through an incision on the left cheek. Under fluoroscopic guidance, a 1 × 8 sub-compact percutaneous lead (Medtronic, Minneapolis, MN, USA) was inserted over the left maxilla, with care to place the distal 2 contact points next to the upper molars. Several adjustments to the lead were necessary before a position was found where no muscle twitching was observed upon testing, even at high amplitude and low frequency stimulation (e.g. 10 A, 2 Hz), see Fig. 1.Fig. 1

Bottom Line: Peripheral nerve/field stimulation may be an effective option for refractory cases, but direct muscle stimulation with facial twitching may result.She received two subsequent treatments of botulinum toxin injections at 5-month intervals with similar results.Botulinum toxin injections may be an effective treatment modality when stimulation techniques provide pain relief but also causes muscle twitching.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA.

ABSTRACT

Background: Facial pain can be a management challenge. Peripheral nerve/field stimulation may be an effective option for refractory cases, but direct muscle stimulation with facial twitching may result. Botulinum toxin injections have been used for blepharospasm and may be effective when facial stimulation results in unacceptable facial muscle twitching due to peripheral stimulation.

Case presentation: A 53-year old female suffered with chronic, refractory facial pain and migraines. Her facial pain began after a root canal of a left upper molar. She was trialed and then permanently implanted with a 1 × 8 sub-compact percutaneous stimulator lead, resulting in improved pain control and reduced medication use. However, she experienced blepharospasm whenever the amplitude was above 2.75 A. Therefore, she was treated with botulinum toxin injections into her bilateral cheek, face, temple and occiput. This treatment provided excellent relief of the facial spasms, allowing her to use her stimulator at high amplitudes, and thereby maximizing her pain relief. She received two subsequent treatments of botulinum toxin injections at 5-month intervals with similar results.

Conclusion: Peripheral nerve/field stimulation is being used for headaches and facial pain. An undesirable side effect of this emerging therapy is direct muscle stimulation. Botulinum toxin injections may be an effective treatment modality when stimulation techniques provide pain relief but also causes muscle twitching.

No MeSH data available.


Related in: MedlinePlus