Hemifacial spasm: Long-lasting Carelessness, Leading to Be Bell's Palsy

 

 

Hemifacial spasm

 

 

 

Hemifacial Spasm

     Hemifacial spasm (HFS) is a neurological disorder that causes involuntary muscle contractions on one side of the face. These spasms occur due to issues affecting the seventh cranial nerve, which controls facial muscles, including those around the eyes, forehead, mouth corners, and superficial neck muscles. Symptoms can arise at any time, and in severe cases, the spasms may cause prolonged muscle contractions, leading to facial asymmetry, an inability to open the affected eye, and an associated "clicking" sound in the ear on the same side.

 

 

Severity of Hemifacial Spasm

     Studies in the United States indicate that hemifacial spasm is more common in females than males, with an incidence of 14.5 cases per 100,000 females and 7.4 cases per 100,000 males. The prevalence is notably higher among Asian populations compared to Western populations.

 

Causes of Hemifacial Spasm

Hemifacial spasm may arise from various causes, including:

 

• Inflammation of the seventh cranial nerve (as seen in Bell’s palsy).
• A vascular loop in the brainstem that compresses the seventh cranial nerve.

 

Less common causes include:

• Brainstem tumors
• Demyelinating diseases, such as multiple sclerosis

 

 

 

 

 

 

Factors That May Trigger or Worsen Symptoms

Certain factors may exacerbate hemifacial spasms, including:

 

• Exposure to loud noises or bright lights
• Chewing, speaking, washing the face, or brushing teeth
• Stress, anxiety, and sleep deprivation
• Prolonged screen time (TV, computer, or mobile devices)

 

Current Treatment Approaches for Hemifacial Spasm

There are three main treatment options for hemifacial spasm:

 

1. Oral Medications

Advantages:

• Non-invasive, with no pain, bleeding, or risk of infection.

 

Disadvantages:

• Most medications used to reduce spasms cause drowsiness, requiring rest and caution with activities like driving.
• Provides only temporary relief; symptoms return when the medication wears off, necessitating continuous use.

 

Examples of Oral Medications: Clonazepam, Carbamazepine, Baclofen

 

 

2. Botulinum Toxin Injection

Advantages:

• A localized procedure with 70–80% effectiveness in reducing spasms.
• Minimal impact on other body systems.

 

Disadvantages:

• Possible side effects include pain, bruising, minor bleeding, drooping eyelids, drooping mouth corners, or local infections. However, modern medical techniques have significantly minimized these risks, and most side effects are temporary.

 

Duration of Effectiveness:

• Botulinum toxin remains effective for 3–4 months, so patients need follow-up injections every 3–4 months, though in some cases, the effects can last up to 6 months.

 

 

Examples of Botulinum Toxin Type A Products: OnabotulinumtoxinA (Botox®), AbobotulinumtoxinA (Dysport®)

 

 

 

 

 

3. Surgery (Microvascular Decompression - MVD)

Advantages:

• If imaging confirms vascular compression of the seventh cranial nerve, surgery can directly relieve the cause of the spasms, offering a highly effective long-term solution.

 

Disadvantages:

• Risks include pain, bleeding, infection, or other complications. However, modern surgical techniques have significantly reduced these risks.

 

Duration of Effectiveness:

• One-time surgery is often sufficient for long-term relief. However, in some cases, spasms may recur, requiring repeat surgery or alternative treatments, such as botulinum toxin injections.

 

 

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Although hemifacial spasm is not a life-threatening condition, it affects the face—a crucial part of one's appearance—leading to self-consciousness and a loss of confidence for many patients.

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Date: November 12, 2020