Hemifacial Spasm

  • Definition

    Hemifacial spasm is a neuromuscular disorder that causes frequent involuntary contractions to occur in the muscles on one side of the face.
  • Causes

    Hemifacial spasm doesn't have a specific cause. It may occur as a result of:
    • A blood vessel pressing on the facial nerve
    • Tumor
    • Facial nerve injury
    • Bony or other abnormalities that compress the nerve
    Muscles of the Face
    Muscles of the Face
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  • Risk Factors

    Hemifacial spasm is more common in middle-aged and elderly women. It is also more common in Asians.
  • Symptoms

    • Intermittent twitching of the eyelid muscle
    • Forced closure of the eye
    • Spasms of the muscles of the lower face
    • Mouth pulled to one side
    • Continuous spasms involving all the muscles on one side of the face
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
    • Electromyography (EMG)—records electrical activity generated in muscle while contracting and relaxing
    • Angiography —uses contrast material to see blood vessels
    Images of internal body structures may be taken with an MRI or CT scan .
  • Treatment

    Talk with your doctor about the best treatment plan for you. Options include:
    Medication
    Your doctor may recommend antiseizure medications to help relieve symptoms.
    Botulinum Toxin Injections
    Injecting botulinum toxin into the affected muscles can stop eyelid spasm for several months. These injections must be repeated, usually several times a year. Botulinum toxin injections are the treatment of choice.
    Surgery
    Microvascular decompression surgery repositions the blood vessel away from the nerve. This is successful in cases of hemifacial spasm where the cause is suspected to be a blood vessel compressing the facial nerve.
  • Prevention

    There are no current guidelines to prevent hemifacial spasm.
  • RESOURCES

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    National Organization for Rare Disorders http://www.rarediseases.org

    CANADIAN RESOURCES

    Canadian Movement Disorder Group http://www.cmdg.org

    Hemifacial Spasm Association http://www.hfs-assn.org

    References

    Alexander GE, Moses H. Carbamazepine for hemifacial spasm. Neurology . 1982;32:286-287.

    Defazio G, Martino D, Aniello MS, et al. Influence of age on the association between primary hemifacial spasm and arterial hypertension. J Neurol Neurosurg Psychiatry . 2003;74:979-981.

    Digre K, Corbett JJ. Hemifacial spasm: differential diagnosis, mechanism, and treatment. Adv Neurol . 1988;49:151-176.

    Ehni G, Woltman HW. Hemifacial spasm. Arch Neurol Psychiatry . 1945;53:205-211.

    Hemifacial spasm. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed July 11, 2013.

    Hemifacial spasm information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/hemifacial%5Fspasm/hemifacial%5Fspasm.htm . Updated October 11, 2011. Accessed July 11, 2013.

    DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine .

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