Hemifacial Spasm (Facial Twitching)

Hemifacial spasm is a long-term condition characterized by involuntary facial twitching. While there is no definitive cure, most individuals can achieve symptom relief through medication, injections, or surgery. Reducing stress and ensuring adequate rest can also help alleviate symptoms.

Overview

What is hemifacial spasm?

Hemifacial spasm is a neurological disorder that results in involuntary muscle spasms on one side of the face.

Who is affected by hemifacial spasm?

Both men and women can develop hemifacial spasm, although it is more prevalent in women over the age of 40.

Symptoms and Causes

What causes hemifacial spasm?

Hemifacial spasm is typically caused by compressed facial nerves. These nerves transmit electrical impulses throughout the body, forming part of the nervous system. Often, a blood vessel pressing against a facial nerve triggers the spasms. Benign head and neck tumors may also exert pressure on the nerves. In some cases, the cause is unknown, termed idiopathic hemifacial spasm.

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What are the symptoms of hemifacial spasm?

Initial symptoms usually include intermittent eye twitching, which can progress to twitching in other parts of the face. Over time, these twitches can become continuous and may worsen with stress or fatigue.
Diagnosis and Tests
How is hemifacial spasm diagnosed?
A neurological examination is conducted to diagnose hemifacial spasm, often followed by an MRI to create detailed images of the brain and surrounding tissues.

Management and Treatment

How is hemifacial spasm treated?

The treatment approach varies based on how severe the symptoms are and may involve:

  • Oral medication.
  • Botulinum toxin type A (Botox®) injections.
  • Hemifacial spasm Surgery

What oral medications are used for hemifacial spasms?

Oral medications may be prescribed for mild symptoms to disrupt the brain’s electrical signals causing spasms. Common medications include:

  • Carbamazepine
  • Clonazepam
  • Baclofen

What are the side effects of oral medications?

Possible side effects include balance issues, drowsiness, nausea, and skin rash.

What are botulinum toxin injections?

In many cases, botulinum toxin injections are the most effective form of treatment. A small amount is injected around the affected muscles to temporarily weaken them and stop the spasms, usually requiring repeat injections every three to six months.

What happens during surgery for hemifacial spasm?

If a blood vessel is pressing on a facial nerve, microvascular decompression (MVD) surgery may be recommended. The procedure involves lifting a small part of the skull, placing a metal plate between the nerve and blood vessel, and closing the skull with another metal plate and screws.

What are the side effects of injections?

After receiving botulinum toxin injections, you may experience eye irritation, eyelid drooping, and temporary facial weakness.

What happens during surgery for hemifacial spasm?

If a blood vessel is pressing on a facial nerve, microvascular decompression (MVD) surgery may be recommended. The procedure involves lifting a small part of the skull, placing a metal plate between the nerve and blood vessel, and closing the skull with another metal plate and screws.
What are the side effects of surgery?
Post-surgery side effects may include decreased hearing and facial weakness.
Is there a cure for hemifacial spasm?
There is no guaranteed cure, but treatments often improve or resolve symptoms for most individuals.
Prevention
How can hemifacial spasm be prevented?
There is no proven method to prevent hemifacial spasm. Related Conditions
Conditions that may exhibit similar symptoms include:
  • Bell’s palsy.
  • Head and neck tumors.
  • Trigeminal neuralgia.
  • Outlook / Prognosis

Is hemifacial spasm a chronic condition?

Hemifacial spasm is typically a chronic condition.

Does hemifacial spasm return after treatment?

Long-term treatment is usually necessary for oral medication or injections, as stopping treatment can lead to the return of spasms. Surgery generally resolves symptoms, but there is still a chance of recurrence.

Living With Hemifacial Spasm

To manage hemifacial spasm, it is important to:

  • Avoid fatigue.
  • Limit caffeine and other stimulants.
  • Manage anxiety.
  • Reduce stress.
  • A note from Cleveland Clinic

Hemifacial spasm is a chronic neuromuscular condition causing uncontrollable twitching on one side of the face. Symptoms often start around the eye and progress downward. Though there is no cure, medications, botulinum toxin injections, or surgery can help manage symptoms. Collaborate with your healthcare provider to determine the best treatment plan.

FAQ's

The early signs of hemifacial spasm typically include intermittent twitching around one eye. This eye twitching may not initially indicate a serious health issue, but if it progresses, it can spread to other areas of the face, leading to continuous and more pronounced spasms.

Hemifacial spasm is diagnosed through a neurological examination, which assesses brain function and nerve health. Doctors often use magnetic resonance imaging (MRI) to create detailed images of the brain and surrounding tissues, helping to identify any compressions or abnormalities affecting the facial nerves.

Treatment options for hemifacial spasm depend on the severity of the symptoms and may include oral medications to disrupt the nerve signals causing the spasms, botulinum toxin injections to temporarily weaken affected muscles, and surgery, such as microvascular decompression (MVD), to relieve nerve compression caused by blood vessels or other structures.