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Tic Douloureux and Facial Spasm

Peter J. Jannetta, MD
JAMA. 1974;228(13):1637-1638. doi:10.1001/jama.1974.03230380015008.
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To the Editor. —  The letter of Donald B. Douglas, MD, of New York (227: 439, 1974) concerned minimal pressure neuropathy. Dr. Douglas' points about hemifacial spasm are certainly indicative of an irritative lesion of the facial nerve. Over the past eight years, we have found this in 41 operative patients with hemifacial spasm, all but two of whom have been totally relieved of their spasm.1,2We have found the same abnormality, compression-distortion of the nerves, in 150 cases of tic douloureux over the past eight years. We have seen five patients with recurrence of pain with this vascular decompression, and more recently, extended the findings to some of the other cranial nerve hyperactivity dysfunction syndromes. The cause is usually vascular, and is due to compression-distortion by a loop of elongated vessel, presumably due to arteriosclerosis, that is irritating the nerve at the root-entry zone, the precise point where


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