Hemifacial spasm

Hemifacial spasm

What is hemifacial spasm?

Hemifacial spasm (facial spasm) is a condition of the nervous system characterized by twitching or severe spasm affecting one side of the face or one of the eyelid.

What may be the causes of hemifacial spasm?

This disease is mainly caused by a blood vessel pressing on the facial nerve, medically called a neurovascular conflict. Hemifacial spasms can also be caused by injury or tumours of or in the vicinity of the facial nerve. In rare cases, it may develop without an identifiable cause.

What examinations should be done for hemifacial spasm?

It is recommended to record a short video of the spasms prior to a visit to the doctor, since the spasms could be absent during the visit, the video may facilitate and simplify the establishment of a diagnosis. It is also recommended not to take any medication that reduce spasms prior to a visit to the doctor so as to make the symptoms as apparent as possible.

Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans of the brain and cranial nerves will be required to establish if there is an underlying neurovascular conflict.

What are the treatment options for hemifacial spasm?

Microvascular decompression surgery. If the cause of hemifacial spasm is neurovascular conflict (the nerve is impinged by a nearby blood vessel), microvascular decompression is the most effective treatment that in most cases completely relieve symptoms (facial spasms). During the operation, the surgeon accesses the affected facial nerve through a small opening in the skull. The nerve is separated from the offending blood vessel and a Teflon liner is inserted between the two structures, thereby preventing further vascular pressure on the nerve.

In cases when surgery is not possible due to co-morbidities alternative options of treatment exist::

  • Botulinum injections. Injections of botulinum toxin (Botox) into the facial muscles affected by the spasms. This causes transient paralysis of these muscles. The effect can last from a few months up to half a year. After this period, the symptoms may return and injections may need to be repeated. Under no circumstances should botulin therapy be carried out without a prior magnetic resonance imaging (MRI) scan of brain!
  • Medications. Antiepileptic medicines, or anticonvulsants such as carbamazepine (Finlepsin), may reduce or completely prevent the appearance of hemifacial spasm in some patients. If the required doses of the medication need to be constantly increased or required at a very high doses initially, or if these medications are not tolerated well by the patient, other treatment options should be considered.