Hemifacial Spasm: Causes, Symptoms and Treatment

It started as a sporadic twitching of her right lower eyelid. Marcie, 51, just chalked it up to eye strain from too much time on her computer. However, when she couldn't control spasms of her cheek, she grew alarmed. A few months later, a neurologist diagnosed the contractions that had spread to the entire right side of her face as classic symptoms of hemifacial spasm.

What is hemifacial spasm?

According to the National Institute of Neurological Disorders and Stroke (NINDS), this is a neuromuscular disorder. Patients experience a lot of involuntary contractions - spasms - of the muscles on just one side of the face.

In severe cases, these tics can occur on both sides of an individual's face, the Neurology Channel reports.

Prevalence and risk factors

While both males and females contract this condition, middle-aged and elderly women appear to experience hemifacial spasms more than other individuals. It's considered a rare affliction, striking just 8 out of every 100,000 men and 15 of every 100,000 women in the United States.

Spasms on the left side of the face are slightly more prevalent than those on the right.

Causes and symptoms

The Neurology Channel indicates that the first sign of hemifacial spasm is typically muscle movement in the patient's eyelid and around the eye. It can vary in intensity.

The intermittent twitching of the eyelid, which can result in forced closure of the eye, gradually spreads to the muscles of the lower part of the face. Ultimately, all the muscles on that side are affected nearly all the time. This sometimes causes the mouth to be pulled to the side.

Experts have linked hemifacial spasm to facial nerve injury, Bell's palsy and tumors. Although the most frequent cause is a blood vessel pressing on the facial nerve at the spot where it leaves the patient's brain stem, sometimes there is no discernible culprit.

When the affected individual is younger than 40, doctors suspect an underlying cause such as multiple sclerosis.

Diagnosis and treatment

Diagnosing a case of hemifacial spasm begins with a complete neurological exam, including an electromyogram. This outpatient test takes about two hours and uncovers problems caused by nerve dysfunction.

Patients have both medical and surgical treatment options. Medical care involves injections of botulinum toxin (Botox) into the muscles affected as well as therapy with muscle relaxants like clonazepam, diazepam and levodopa. Microvascular decompression is a surgical procedure that relieves pressure on the facial nerve for many sufferers.

The prognosis varies among patients according to their response to treatments. While some are eventually symptom-free, others might require repeat surgery. The remaining patients are left with varying degrees of frequency and intensity of spasms while they continue on long-term drug therapy.

Research

Current research is underway at NINDS at The National Institutes of Health (NIH). Most of it focuses on improved methods of prevention and treatment as well as finding an eventual cure for many neurological disorders such as hemifacial spasm.

Sources:

National Institute of Neurological Disorders and Stroke (NINDS) site

Neurology Channel site