Hemifacial spasm (HFS) is a chronic condition that typically does not go away without treatment. This nervous system disorder progresses gradually and may be visible in other muscles on the same side of the face. Gradually, spasms may eventually become permanent if left untreated.
What are symptoms of hemifacial spasm?
HFS is a rare disease that usually starts around the eye, causing it to twitch, blink, squeeze, or close. Sometimes, the eye on the affected side looks smaller or the eyelid looks droopy.
Over time, the condition affects the cheek area, causing the corner of the mouth to tighten and pull up. HFS may eventually affect the neck muscles and cause a clicking sound due to the involvement of the muscle in the middle ear.
Signs and symptoms may include:
- Major spasms on one side of the face that affect both the cheek and mouth
- Spasms that extend across the face, right up to the chin
- Mouth pulled to one side
- Changes in hearing
- Pain behind the ear
Symptoms often begin with mild intermittent twitching of one eyelid and may progress to the lower face. In more severe cases, it may progress to intense and continuous muscle spasms on one whole side of the face.
While the twitching is usually not painful, it can be embarrassing and interfere with normal expression and vision. Many individuals who suffer from hemifacial spasms find their condition socially isolating and can suffer from additional conditions, such as anxiety or depression.
What causes hemifacial spasms?
Hemifacial spasm is caused by the facial nerve becoming compressed, which leads to malfunctioning of the muscles responsible for facial expression. Compression causes the nerve to misfire, making the facial muscles contract involuntarily. Increased activity of the facial nerve is thought to be caused by irritation from a blood vessel adjacent to the nerve deep within the brain.
Risk factors and common causes may include:
- Age (more common in people over 40)
- Gender (more common in women)
- Ethnicity (more common in people of Asian ethnicities)
- Enlarged blood vessels
- Facial movements (smiling, talking, eating, blinking, etc.)
- Injury to the head or face
- Stress or anxiety
- Fatigue or lack of sleep
- Caffeine intake
In rare cases, HFS may be caused by:
What are treatment options for hemifacial spasms?
Although there is no guaranteed cure for HFS, available treatments include:
- Botox disrupts nerve messages to the muscles and causes muscles to relax, stopping the spasms.
- Multiple injections are usually given both above and below the eye and in the cheek.
- Muscle weakening begins after about 1-4 days, with effects lasting up to 4 months.
- Treatment works for about 70% -80% of people with hemifacial spasms.
- Anti-epileptic and benzodiazepine medications can be helpful when spasms are mild or infrequent, and they work by calming nerve impulses.
- Responses to these medications can vary, and it may take time to get the dosage right.
- These medications will need to be taken on a long-term basis.
- Vascular decompression can relieve compression caused by blood vessels on the facial nerve.
- While surgery can be curative, it can also cause serious side effects.
- For this reason, surgery is usually reserved for cases where the spasms are severe and disabling and when other treatments have failed.
The prognosis for each patient varies according to the severity of the condition. For some, symptoms are successfully managed with minimal intervention. For others, more than one form of treatment is needed before the condition is completely controlled.
The National Institute of Neurological Disorders and Stroke. Hemifacial Spasm Information Page. https://www.ninds.nih.gov/Disorders/All-Disorders/Hemifacial-Spasm-Information-Page
Rosenstengel C, Matthes M, Baldauf J, Fleck S, Schroeder H. Hemifacial Spasm: Conservative and Surgical Treatment Options. Dtsch Arztebl Int. 2012;109(41):667-673. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487151/
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