Painful tic convulsif: Case series and literature review

• Published in: Cirugia y cirujanos 2016-11, Vol.84 (6), p.493
• Main Authors: Revuelta-Gutiérrez, Rogelio, Velasco-Torres, Héctor Sebastián, Vales Hidalgo, Lourdes Olivia, Martínez-Anda, Jaime Jesús
• Format: Article
• Language: eng ; spa
• Subjects: Aged; Basilar Artery - diagnostic imaging; Basilar Artery - pathology; Basilar Artery - surgery; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Female; Follow-Up Studies; Hemifacial Spasm - drug therapy; Hemifacial Spasm - etiology; Hemifacial Spasm - physiopathology; Hemifacial Spasm - surgery; Humans; Magnetic Resonance Angiography; Male; Microvascular Decompression Surgery - methods; Middle Aged; Nerve Compression Syndromes - complications; Nerve Compression Syndromes - drug therapy; Nerve Compression Syndromes - physiopathology; Nerve Compression Syndromes - surgery; Trigeminal Neuralgia - drug therapy; Trigeminal Neuralgia - etiology; Trigeminal Neuralgia - physiopathology; Trigeminal Neuralgia - surgery; Vertebral Artery - diagnostic imaging; Vertebral Artery - pathology; Vertebral Artery - surgery
• ISSN: 0009-7411

The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment.