Hemifacial Spasm: Prevent Facial Paralysis

     Hemifacial Spasm (HFS) is a movement disorder characterized by involuntary muscle contractions on one side of the face. Most cases involve "twitching" on one side, resulting from issues with the 7th cranial nerve (facial nerve) which controls facial muscles, including those around the eyes, forehead, corners of the mouth, and superficial neck muscles. Symptoms can occur at any time. In severe cases, the twitching may lead to sustained spasms, causing facial and mouth distortion, inability to open the eye on the affected side, and a "clicking" sound in the ear.

Prevalence and Severity of Hemifacial Spasm

     Studies on the prevalence of HFS in the United States show it is more common in women than men, occurring in approximately 14.5 cases per 100,000 in women and about 7.4 cases per 100,000 in men. However, prevalence is higher among Asian populations compared to Western populations.

Causes of Hemifacial Spasm

HFS can be caused by several factors, such as:

• Complications from 7th Cranial Nerve Inflammation (Bell’s Palsy)
• A vascular loop near the brainstem pressing against the 7th cranial nerve.

Other less common causes of HFS include:

• Brainstem tumors
• Demyelinating diseases

Triggers for Worsening Symptoms

Examples of factors that may trigger increased twitching:

• Loud noises or bright lights
• Chewing, talking, washing your face, or brushing teeth
• Stress, anxiety, and sleep deprivation
• Prolonged screen time (TV, computer, or phone)

Current Treatment Guidelines for Hemifacial Spasm

Current treatment approaches are divided into 3 methods:

1.  Oral Medication

• Pros: No pain, bleeding, or infection risks associated with injections or surgery.
• Cons: Most spasm-reducing medications cause drowsiness; patients should rest and avoid driving after use.
• Duration: Medication only provides temporary relief and must be taken continuously.
• Common Medications:
  • Clonazepam
  • Carbamazepine
  • Baclofen

2.  Botulinum Toxin Injections

• Pros: Targeted treatment with high efficiency (70-80% reduction) and does not affect other systems.
• Cons: Possible pain, bruising, eyelid drooping, or drooping mouth. These side effects are now rare or temporary.
• Duration: Effects last 3-4 months; patients should follow up for repeat treatment accordingly.
• Common Brands:
  • OnabotulinumtoxinA (Botox^®)
  • AbobotulinumtoxinA (Dysport^®)

3.  Microvascular Decompression Surgery

• Pros: Highly effective and addresses the root cause if imaging clearly identifies vascular compression of the 7th nerve.
• Cons: Risk of pain, bleeding, or surgical complications. Modern techniques have significantly reduced these risks.
• Duration: One surgery is usually sufficient for long-term results, though some patients may experience recurrence.

While Hemifacial Spasm is not life-threatening, it can significantly impact self-confidence as the face is a central part of one's identity.

Last Updated

12/11/2020