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Hemifacial Spasm

By

Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Sep 2020| Content last modified Sep 2020
Click here for the Professional Version
Topic Resources

Hemifacial spasm is painless involuntary twitching of one side of the face due to malfunction of the 7th cranial (facial) nerve and/or the area of the brain that controls it (called a center or nucleus). This nerve moves the facial muscles, stimulates the salivary and tear glands, enables the front two thirds of the tongue to detect tastes, and controls a muscle involved in hearing.

  • Twitching may occur only occasionally at first but may become almost constant.

  • Doctors diagnose hemifacial spasm based on symptoms but do magnetic resonance imaging to check for other disorders that can cause similar symptoms.

  • Hemifacial spasm is treated with botulinum toxin or another drug, but if drugs are ineffective, surgery may be necessary.

Hemifacial spasm affects men and women but is more common among middle-aged and older women.

The spasms may be caused by

  • An abnormally positioned artery or loop of an artery that puts pressure on (compresses) the facial cranial nerve where it exits the brain stem

Symptoms

Muscles on one side of the face twitch involuntarily, usually beginning with the eyelid, then spreading to the cheek and mouth. Twitching may be intermittent at first but may become almost continuous.

Hemifacial spasm is essentially painless but can be embarrassing and look like a seizure.

Diagnosis

  • A doctor's evaluation

  • Magnetic resonance imaging

Hemifacial spasm is diagnosed when doctors see the spasms.

Magnetic resonance imaging (MRI) should be done to rule out tumors, other structural abnormalities, and multiple sclerosis, which can cause similar symptoms. Also, MRI can usually detect the abnormal loop of artery pressing against the nerve.

Treatment

  • Botulinum toxin

  • Sometimes surgery

Botulinum toxin (used to paralyze muscles or to treat wrinkles) is the drug of choice for hemifacial spasm. It is injected into the affected muscles. The same drugs used to treat trigeminal neuralgiacarbamazepine, gabapentin, phenytoin, baclofen, and tricyclic antidepressants—can also be used.

If drug treatment is unsuccessful, surgery (called vascular decompression) may be done to separate an abnormal artery, if present, from the nerve by placing a small sponge between them.

Taking the Pressure Off a Nerve

When pain results from an abnormally positioned artery pressing on a cranial nerve, the pain can be relieved by a surgical procedure called vascular decompression.

The procedure for the facial nerve in people with hemifacial spasm is similar to that for the trigeminal nerve (shown below).

If the trigeminal nerve is compressed, an area on the back of the head is shaved, and an incision is made. The surgeon cuts a small hole in the skull and lifts the edge of the brain to expose the nerve. Then the surgeon separates the artery from the nerve and places a small sponge between them.

A general anesthetic is required, but the risk of side effects from the procedure is small. Usually, vascular decompression relieves the pain.

Taking the Pressure Off a Nerve
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