Hemifacial Spasm

Hemifacial spasm is a neuromuscular disorder characterized by frequent, involuntary muscle contractions (tics or spasms) in the face, typically starting around the eye. It usually affects only one side of the face, but, in severe cases, spasms may occur on both sides and may cause the mouth to become clamped shut, making speaking, eating and swallowing difficult. One or both eyes may involuntarily contract, obstructing vision. The disorder occurs in both men and women, although it more commonly affects middle-aged women.

Cause of Hemifacial Spasm

The condition may be caused by a facial nerve injury or a tumor, or it may have no apparent cause. Very commonly, hemifacial spasm is caused by irritation of the seventh cranial nerve (the facial nerve). A small blood vessel is often found compressing the root entry zone of the facial nerve at the brainstem.

Symptoms of Hemifacial Spasm

The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously.

Diagnosis of Hemifacial Spasm

As always, a careful history and physical examination are the first steps in diagnosis. If hemifacial spasm is suspected, an electromyogram (EMG) is ordered. The blood vessel pressing on the facial nerve is usually too small to be detected by magnetic resonance imaging (MRI), computed tomography (CAT scan), or angiography, but these tests may be obtained to rule out any other possible conditions contributing to the facial spasms.

Treatment of Hemifacial Spasm

There are three accepted treatments for hemifacial spasms: medications, surgery and the use of botulinum toxin injections, commonly known as Botox.

In mild cases, the first line of therapy is medication. Although these treatments are not always successful, limited success has been reported in controlling the spasms with medications.

When hemifacial spasm symptoms are severe and the cause is suspected to be related to a blood vessel impinging upon the facial nerve, microvascular decompression is an effective method of treatment. Performed by a qualified neurosurgeon, the surgery repositions the blood vessel away from the nerve. This treatment is usually successful and most patients do not require further treatment.

Some physicians have reported good results with botulinum toxin (Botox) injections into the affected muscles. It is quite safe and very effective in stopping eyelid spasm for up to several months. Because the effects are temporary, this treatment must be repeated, usually several times per year.

Call 1-800-411-CINN between 8 AM and 5:30 PM central time, Monday through Friday to schedule an initial consultation with a CINN physician.