Difference between revisions of "1° Clinical case: Hemimasticatory spasm"

1° Clinical case: Hemimasticatory spasm (view source)

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 This could be responsible for the high frequency of EMG discharges at a frequency of 100-200 Hz and the synchronization of the entire muscle or multiple muscles, and post-activity. The synchronization could be explained by the lateral spread of discharges from adjacent nerve fibers,<ref>Nielsen VK. [https://pubmed.ncbi.nlm.nih.gov/6322049/ Pathophysiology of hemifacial spasm: II. Lateral spread of the supraorbital nerve reflex]. Neurology 1984;34:427-31.</ref><ref>Thompson PD. Stiff people. In Fahn S, Marsden CD, eds. Movement disorders 3. London: Butterworths, 1993: 367-99.</ref> generating a local re-excitation circuit. Posthumous EMG activity consists of paroxysmal discharges that may follow a voluntary orthodromic contraction or antidromic impulses,<ref>Auger RG. [https://pubmed.ncbi.nlm.nih.gov/573406/ Hemnifacial spasm: clinical and electrophysio- logic observations.] Neurology 1979;29: 1261-72.</ref><ref name=":1">Nielsen VK. [https://pubmed.ncbi.nlm.nih.gov/6322048/ Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation.] Neurology 1984;34:418-26.</ref> and is attributed to self-excitation of the same axons after the passage of an impulse.
-In our patient Mary Poppins we observed a synchronization of the whole or a large part of the muscle involved in the spasm (fig 10, EMG); the self-excitation is evidenced by the recording of the evoked discharges following the response of the stimulation of the chewing nerves (Fig. 10, E). These results support the hypothesis that spontaneous activity 'arises' in a demyelinated peripheral nerve, a phenomenon called hepaptic.<ref name=":1" />{{Q2|In conclusion, the patient was affected by 'Hemimasticatory Spasm' mainly focused on the right masseter muscle but with indirect diffusion of the phenomenon to the right temporal muscle probably due to hepaptic activity due to the demyelination of the masticatory motor nerves in the infratemporal fossa. Botulinum endotoxin therapy was started immediately with total regression of the disease 10 years later.}}
+In our patient Mary Poppins we observed a synchronization of the whole or a large part of the muscle involved in the spasm (fig 10, EMG); the self-excitation is evidenced by the recording of the evoked discharges following the response of the stimulation of the chewing nerves (Fig. 10, E). These results support the hypothesis that spontaneous activity 'arises' in a demyelinated peripheral nerve, a phenomenon called hepaptic.<ref name=":1" />
+In conclusion, the patient was affected by 'Hemimasticatory Spasm' mainly focused on the right masseter muscle but with indirect diffusion of the phenomenon to the right temporal muscle probably due to hepaptic activity due to the demyelination of the masticatory motor nerves in the infratemporal fossa. Botulinum endotoxin therapy was started immediately with total regression of the disease 10 years later.
+{{Q2|But how do we get to decrypt a machine language code?|we will try to describe it in the chapter 'Crypted code: Ephaptic transmission' at the end of the section 'Hemasticatory spasm'}}
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