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Hemifacial Spasm by Krisha McCoy, MS

Definition

Hemifacial spasm is a neuromuscular disorder that causes frequent involuntary contractions to occur in the muscles on one side of the face.

Causes

Hemifacial spasm is believed to be due in part to compression of the facial nerve where it meets the brainstem. The compression can be cause by:

A blood vessel pressing on the facial nerve (most frequent cause)
Tumor
Facial nerve injury
Bony or other abnormalities that compress the nerve

Muscles of the Face

Risk Factors

The following factor increases your chance of developing hemifacial spasm:

Being a middle-aged or elderly woman
Hypertension

Symptoms

Intermittent twitching of the eyelid muscle
Forced closure of the eye
Spasms of the muscles of the lower face
Mouth pulled to one side
Continuous spasms involving all the muscles on one side of the face

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

Electromyography (EMG) —a test that measures and records electrical activity generated in muscle at rest and in response to muscle contraction
Magnetic resonance imaging (MRI) —a test that uses magnetic waves to make pictures of structures inside the head
Computed tomography (CT) scan —a type of x-ray that uses a computer to make pictures of structures inside the head
Angiography —an x-ray exam of the blood vessels when they are filled with a contrast material

Treatment

Hemifacial spasm is usually a chronic condition. Remission of symptoms, although possible, has only been noted to occur in less than 10% of patients.

Talk with your doctor about the best treatment plan for you. Treatment options include:

Medication

Carbamazepine —This is often used initially, with improvement in symptoms in up to half of patients who are treated.
- According to the Food and Drug Administration (FDA), patients of Asian ancestry who have a certain gene, called HLA-B*1502, and take carbamazepine are at risk for dangerous or even fatal skin reactions. If you are of Asian descent, the FDA recommends that you get tested for this gene before taking carbamazepine. If you have been taking this medicine for a few months with no skin reactions, then you are at low risk of developing these reactions. Talk to your doctor before stopping this medicine.
Gabapentin and baclofen —These may also be beneficial for treating hemifacial spasm in some patients.

Botulinum Toxin Injections

Injecting botulinum toxin (ie, Botox) into the affected muscles can stop eyelid spasm for several months. These injections must be repeated, usually several times a year. Botulinum toxin injections are the treatment of choice.

Surgery

Microvascular decompression surgery repositions the blood vessel away from the nerve. This is successful in cases of hemifacial spasm where the cause is suspected to be a blood vessel compressing the facial nerve.

Prevention

There is no known way to prevent hemifacial spasm.

RESOURCES:

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/
National Organization for Rare Disorders http://www.rarediseases.org/

CANADIAN RESOURCES:

Canadian Movement Disorder Group http://www.cmdg.org/
Hemifacial Spasm Association http://www.hfs-assn.org/

References:

Alexander GE, Moses H. Carbamazepine for hemifacial spasm. Neurology. 1982;32:286-287.
Defazio G, Martino D, Aniello MS, et al. Influence of age on the association between primary hemifacial spasm and arterial hypertension. J Neurol Neurosurg Psychiatry. 2003;74:979-981.
Digre K, Corbett JJ. Hemifacial spasm: differential diagnosis, mechanism, and treatment. Adv Neurol. 1988;49:151-176.
Ehni G, Woltman HW. Hemifacial spasm. Arch Neurol Psychiatry. 1945;53:205-211.
Hemifacial spasm. Chicago Institute of Neurosurgery and Neuroresearch website. Available at: http://www.cinn.org/other/hemifacial-spasm.html . Accessed February 28, 2007.
Hemifacial spasm. MedLink Neurology website. Available at: http://www.medlink.com . Accessed 4/2/2008.
Hemifacial spasm information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/hemifacial_spasm/hemifacial_spasm.htm . Accessed February 28, 2007.
Vinken PJ, Bruyn GW. Handbook Of Clinical Neurology. Amsterdam: North-Holland Publishing Company; 2011: 675-680.
DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine .

Last reviewed March 2013 by Rimas Lukas, MD

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