PMC9974163_01
(A-C) Changes in the patient's hemifacial and cervical dystonia over time. (A) Pre-implant surgery, the dystonia on the left side of the patient's face is seen, manifesting as an involuntary contraction of the left hemifacial. (B) Satisfactory relief of the dystonia is still evident at 6 months after PNS surgery. (C) Involuntary contraction of the left-sided facial muscles reappeared at 12 months after PNS surgery. (D) Anteroposterior radiograph of the cranium demonstrating the placement of the supraorbital PNS-stimulating electrodes. (E, F) Bilateral forehead skin biopsy using immunolabeled protein gene product 9.5 demonstrating markedly lower epidermal neurite (yellow arrows) density in the left forehead (F) vs. that in the right forehead (E). PNS, peripheral nerve stimulation.
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F1
The hemifacial dystonia had persisted for 4 months at the time of admission (Figure 1A). Labeled with protein gene product 9.5, the immunohistochemistry of the left forehead revealed severe denervation of intra-epidermal and dermal nerve fibers (Figures 1E, F). Second, a PNS electrode (Model 3777, Medtronic, Minneapolis, MN, USA) was implanted percutaneously from the left temporal region to the ipsilateral supraorbital notch, along the brow arch (Figure 1D). He was satisfied with the efficacy of PNS (Figure 1B). However, the dystonia recurred gradually at 12 months after the surgery, and the pain-relieving effect persisted; however, the facial dystonia had worsened (Figure 1C; Table 1).