Hemifacial Spasms
Overview
Hemifacial spasms are involuntary twitches or contractions on one side of the face. These twitches are paroxysmal spurts of involuntary tonic or clonic activity in the muscles that innervated by the facial nerve.

When spasms occur, the facial muscles, which are operated by the facial nerve (seventh cranial nerve), have sudden spurts of involuntary tonic and clonic activity. The facial nerve is what moves the lips, mouth, raises and lowers the eyebrows, and also closes the eyelids. These facial contractions can happen sporadically or can be constant but occur often and involuntarily.

 Hemifacial spasms can occur due to damage to the facial nerve, compression on the nerve from a blood vessel, and also Bell’s palsy, also known as idiopathic facial paralysis. The most prevalent cause is pressure from a blood vessel which causes the nerve to misfire, triggering the contraction.

Symptoms

Spasms often begin with quick involuntary twitching around the eye or closure of the eyelid. As the condition worsens the spasms progress further down the face causing involuntary movements with the middle of the face all the way down to the lower side around the mouth. On occasion, small activities such as sneezing or reading can increase a patient’s symptoms. Even things such as stress or fatigue can cause the symptoms to worsen.

While the spasms do not threaten one’s immediate health and do not usually cause pain, the condition is embarrassing and upsetting for the patient and can sometimes interfere with one’s vision.

Diagnosis

A review of the patient’s medical history is conducted, followed by a thorough neurological exam. Once the exam is complete an MRI is often taken to ensure that other conditions such as a tumor or aneurysm is not causing the pressure on the facial nerve. Next, an electromyography (EMG) is performed, which records the electrical activity of the muscles in the face.

Treatment

In less severe cases the twitching can be calmed by the use of anti-seizure drugs or muscle relaxers. However these drugs need to be taken regularly and the method of treatment is not always successful. Other forms of treatments include a Botulinum toxin (Botox) injection which inhibits the release of acetycholine. Acetycholine is neurotransmitter that carries the electrical messages to and tells the muscle to move. With this treatment a needle is used to inject the specified muscle 1 to 3 times. This procedure is often considered a temporary treatment because although the injections can be repeated indefinitely, they usually become ineffective after about a year as the body begins to build a tolerance to the toxin.

An effective treatment of hemifacial spasms is a procedure called Microvascular Decompression (MVA) on the facial nerve. This involves an incision and skull opening in which the posterior cranial fossa can be looked at and the facial nerve can be viewed as it leaves the brainstem. Once the compressing blood vessel is seen it will be pushed away from the facial nerve and padded with a piece of Teflon. This procedure has a lasting result that provides spasm relief for the majority of patients for the remainder of their lives.

Prognosis

Although hemifacial spasms are not life threatening they can be very troublesome to the patient and can affect one’s quality of life. The condition can get worse throughout the patient’s lifetime but the surgical treatment relieves the spasm permanently for the majority of patients.

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