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Hemifacial Spasm

By Michael Rubin, MDCM, Professor of Clinical Neurology; Attending Neurologist and Director, Neuromuscular Service and EMG Laboratory, Weill Cornell Medical College; New York Presbyterian Hospital-Cornell Medical Center

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Hemifacial spasm refers to unilateral painless, synchronous contractions of facial muscles due to dysfunction of the 7th cranial (facial) nerve and/or its motor nucleus.

Hemifacial spasm usually results from nerve compression by a pulsating blood vessel, similar to that in trigeminal neuralgia.

Unilateral, involuntary, painless contractions of facial muscles usually begin in the eyelid, then spread to the cheek and mouth. Contractions may be intermittent at first but may become almost continuous.

The pulsating blood vessel is often visible on MRI, but diagnosis of hemifacial spasm is ultimately clinical. Focal seizures, blepharospasm, and tics cause similar symptoms and should be considered.

The most effective treatment for hemifacial spasm is

  • Injection of botulinum toxin (botulinum toxin type A or botulinum toxin type B)

Treatments for trigeminal neuralgia (eg, anticonvulsants, baclofen, amitriptyline, surgery) can also be used.