(See also Overview of Neuro-ophthalmologic and Cranial Nerve Disorders Overview of Neuro-ophthalmologic and Cranial Nerve Disorders Dysfunction of certain cranial nerves may affect the eye, pupil, optic nerve, or extraocular muscles and their nerves; thus, they can be considered cranial nerve disorders, neuro-ophthalmologic... read more .)
Hemifacial spasm usually results from nerve compression by a pulsating blood vessel that causes ectopic impulse generation (ephaptic nerve impulses), 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) into affected muscles
Treatments for trigeminal neuralgia Treatment Trigeminal neuralgia is severe paroxysmal, lancinating facial pain due to a disorder of the 5th cranial nerve. Diagnosis is clinical. Treatment is usually with carbamazepine or gabapentin; sometimes... read more (eg, antiseizure drugs, baclofen, amitriptyline, microvascular decompression) can also be used.
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