Hemifacial Spasm (Face Twitching): Types & Treatment

What is Hemifacial Spasm?

Hemifacial spasm causes involuntary painless twitching on one side of the face due to malfunctioning of the seventh cranial nerve, also known as the facial nerve. It causes the muscles on one side of the face to contract. In its mildest form, the condition may cause no more harm other than slight inconvenience. However, in severe cases, the contractions may interfere with vision. In hemifacial spasm, muscles on one side of the face twitch involuntarily, beginning with the eyelid and then spreading to the cheek and mouth. Twitching may be irregular at first but may become frequent afterwards. The spasms may be caused by an abnormally positioned loop of an artery that compresses the facial cranial nerve where it exits the brainstem. Medical experts have suggested that the condition is caused by disturbances within the facial nerve.

The disease has two forms - typical and atypical hemifacial spasm. In typical hemifacial spasm, twitching starts in the lower eyelid. It spreads to the whole lid, and then to the orbicularis oris muscle around the lips. The reverse occurs in a typical hemifacial spasm in which twitching starts in the orbicularis oris muscle around the lips, and progresses up to the orbicularis oculi muscle present in the eyelid.

Symptoms

The very first sign of the disease is the movement of muscles in the eyelid and around the eye. It progresses gradually and may be visible in other muscles on the same side of the face, specifically the mouth and jaw. Some people may have a mild form of the disease. The symptoms generally occur on one side of the face, but they can also occur on both sides. Symptoms include:

Minor twitching of an eyelid, which may cause the eye to close.
Changes in hearing.
Pain behind the ear.
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.

Causes

The major cause of hemifacial spasm is the pressure on the facial nerve due to abnormality in the brain. In case of no obvious cause, it is known as idiopathic hemifacial spasm. Other secondary causes that cause damage to the brain may include:

Vascular compression.
Brainstem lesions.
Trauma.

Risks

The major risk factors are:

It is more common in middle aged and elderly women.
Smoking can be a rare factor associated with it.

Prevention

There is no known prevention for hemifacial spasm.

How is it diagnosed?

At Medanta, following technologies may be used to identify hemifacial spasm:
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Electromyography
MRI (magnetic resonance imaging) scan

How is it treated?

The treatment of hemifacial spasm at Medanta may include:

Botulinum injections
The doctor may inject botox into the affected muscles, temporarily paralyzing them. Additional treatments are required after every few months.
Microvascular decompression surgery
The surgeon makes an opening in the skull and opens the covering of the brain (dura) to expose the facial nerve as it leaves the brainstem. It relieves the facial nerve from pressure.
Medication
Certain medications such as anticonvulsant drugs can also relieve hemifacial spasm.

When do I contact the doctor?

You need to consult a doctor, if you experience frequent twitching of the facial nerve. Facial twitching is something that is considered quite normal. However, if it lasts more than a week, it must be taken seriously and medical help should be sought to identify the cause and carry out the necessary treatment.

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