The Origin of the Abnormal Muscle Response Seen in Hemifacial Spasm Remains Controversial

We read with interest the manuscript by Kameyama et al. (2016) entitled "Ephaptic Transmission is the origin of the abnormal muscle response seen in hemifacial spasm". The authors describe an elegant electrophysiological study designed to elucidate the pathophysiological mechanisms underlying this condition. Their conclusions are in support of the peripheral theory of ephaptic transmission. Following a careful review of their interpretation of results and conclusions, we respectfully suggest the central theory of abnormal hyper-excitability of the facial nucleus remains a more likely cause of hemifacial spasm.

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