Hemifacial spasm is a condition that affects half of your face. It usually starts with a twitching around one eye. It may gradually involve your mouth also. There are different types of treatment. Although the condition is not dangerous, it can affect quality of life.
What is hemifacial spasm?
A spasm is a sudden, involuntary contraction of a muscle or a group of muscles. Hemifacial means half of the face.
The muscles of the face are all controlled by the facial nerve. There is a facial nerve for each side of the face. It starts deep inside your brain and makes its way past many structures to reach the face. The facial nerve carries signals from the brain to make your facial muscles contract or relax. For example, the facial nerve makes you blink, twitch your nose and pout your lips.
If something presses on the nerve somewhere along its course, it can affect how the signals are carried to the face. This may cause muscles to twitch (or contract), or to go into spasm, when you don't want them to.
More temporary twitches of the muscles of the face are NOT hemifacial spasm. For example, facial tics and twitches, and muscle spasms around the eyes (blepharospasm) are different conditions. In these other conditions often both sides of the face can be affected, although not necessarily at the same time.
How common is it?
Hemifacial spasm is a rare condition. In the UK there are thought to be about 4,000 people with hemifacial spasm. It affects men and women, although women tend to be affected slightly more often than men. Symptoms usually start in middle age.
What causes it?
The cause of hemifacial spasm is not fully understood. At the moment, doctors believe the main cause is pressure on the facial nerve from a structure or abnormality within the brain. The most common finding is a blood vessel at the base of the brain, pressing on the nerve. There are other, rare causes too such as infections or strokes. Sometimes there is no obvious cause and doctors may then call it idiopathic hemifacial spasm. Idiopathic means 'of unknown cause'.
Is it inherited?
Because the causes of hemifacial spasm are not inherited, it is unlikely that you will pass the condition on to your children.
What are the symptoms of hemifacial spasm?
Twitching usually begins around the eye. At first the twitching spasms may come and go. Gradually the spasms become worse and the spasm may become permanent. The left side is more often affected than the right. The twitches may spread to involve other muscles on the same side of the face. The mouth and jaw are often involved. The corner of the mouth can become pulled up by permanent spasm. Some people also hear a clicking sound on the side that is affected when the spasm comes.
Some people may have quite a mild condition that causes inconvenience and embarrassment. Others find the spasms may affect their vision and their ability to drive. As the other eye is not affected, they are still able to see.
For some people the spasms may become worse when they are tired and stressed. They may also improve when they lie down.
How do doctors diagnose it?
If you are worried about twitching on one side of your face, you should see your GP. They will ask questions about what has happened and how it is affecting you. They may examine you. If they think it might be hemifacial spasm, they will refer you to a consultant who specialises in nerves (a neurologist). Some neurologists specialise in movement disorders such as hemifacial spasm.
What treatments are available for hemifacial spasm?
Although there is no guaranteed cure currently, various treatments are available.
These can occasionally be helpful when the spasms are mild or infrequent. Anti-epileptic medicines such as carbamazepine and topiramate can be helpful in some people with hemifacial spasm. These medicines work by quieting nerve impulses. The response to these medicines can vary and it may take time to get the right dose. They will need to be taken on a long-term basis. The treatments below are usually preferable options.
Botulinum toxin is produced by the bacterium Clostridium botulinum. It is usually associated with causing food poisoning called botulism. However, when it is used in controlled doses, it is safely used to relax excessive muscle contraction. It is injected into the facial muscles and blocks the signal from the nerve. This helps to stop the spasms. Botulinum toxin is better known as Botox®, and it is used more often in cosmetic surgery. The effects of the injection last for two to three months and it starts to work within a few days. At least 7-8 people out of 10 with hemifacial spasm are helped by botulinum injections. However, repeated injections are needed every 3 to 4 months as the effect wears off.
There can be side-effects of the injection. These are commonly drooping of the eyelid and double vision. The side-effects usually wear off after 1 or 2 weeks.
There are several surgical procedures that can be done. Microvascular decompression is one type. It involves moving the blood vessel that may be pressing on the facial nerve. This often cures the condition but may be unsuitable for some patients with hemifacial spasm. It is successful in 9 out of 10 people with hemifacial spasm. There can rarely be some serious side-effects that may occur as a result of surgery, such as hearing damage or permanent paralysis of the face. For this reason, surgery is usually reserved for cases where the spasms are severe and disabling. Surgery is also used when other treatments have failed to work or if you are young and don't want long-term repeated injections.
Is there anything I can do to help myself?
Learning relaxation techniques may benefit some people. Educating yourself about your condition and staying positive can also help. Other complementary therapies such as homeopathy or acupuncture do not seem to help this condition.
What is the outlook (prognosis)?
Hemifacial spasm is usually a long-term condition. It is not dangerous or fatal but may affect your quality of life. It very rarely improves completely without treatment.
Further reading and references
Han IB, Chang JH, Chang JW, et al; Unusual causes and presentations of hemifacial spasm. Neurosurgery. 2009 Jul65(1):130-7
Yaltho TC, Jankovic J; The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord. 2011 Aug 126(9):1582-92. doi: 10.1002/mds.23692. Epub 2011 Apr 5.
Rosenstengel C, Matthes M, Baldauf J, et al; Hemifacial spasm: conservative and surgical treatment options. Dtsch Arztebl Int. 2012 Oct109(41):667-73. doi: 10.3238/arztebl.2012.0667. Epub 2012 Oct 12.
Costa J, Espfrito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, Sampaio C. Botulinum toxin type A therapy for hemifacial spasm. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004899. DOI: 10.1002/14651858.CD004899.pub2.
Miller LE, Miller VM; Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg. 2012 Aug26(4):438-44. doi: 10.3109/02688697.2011.641613. Epub 2011 Dec 15.
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