Hemifacial Spasm
This is a relatively rare condition that causes involuntary contractions/spasms of one side of the face. The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously.
How is it diagnosed?
Hemifacial spasm is a clinical diagnosis based on history and examination findings consistent with the condition. Once a diagnosis has been established investigations are then undertaken to establish if there is an underlying cause that can be seen, for example a tumour or an artery in contact with the facial nerve/distorting it. This is typically looked at by performing an MRI scan of the brain with contrast.
What treatments are available?
Drug treatments are generally not particularly effective in the treatment of hemifacial spasm. The two main options for managing hemifacial spasm currently are with botox injections and microvascular decompression. Some people find that taking regular magnesium supplementation can reduce the severity of spasms but there are no studies specifically looking at this and this is not a curative measure.
Botox Injections
These are widely used in patients with hemifacial spasm and can help reduce the severity of the spasms for many. They are targeted at improving the symptoms rather than offering a potential cure. These are typically performed by neurologists in the UK healthcare setting.
Microvascular decompression
If there is an artery seen to be compressing/distorting the nerve on MRI scanning surgical management can be undertaken in the form of a microvascular decompression. This is a potentially curative procedure with long term success rates of between 75 and 90% in correctly identified patients.
Microvascular decompression is a neurosurgical operation that is performed under general anaesthetic. A craniotomy (opening) at the back of the head behind the ear is performed and the vascular structures that are compressing or distorting the nerve (seen on MRI scans) are separated away from the nerve. Typically this procedure requires a hospital stay of 2-3 days during which time people often have increased headaches and some unsteadiness on their feet. Generally there is a recommended recovery time of 6 weeks away from work and not to travel by aeroplane in that period. For more information on this please see the section on 'What is it like to have a neurosurgery operation?'. The risks of the procedure include it not working, those of a general anaesthetic including a small risk of stroke or to life, infection (superficial/deep/meningitis), leak of CSF from the wound requiring repair and/or CSF diversion, double vision, hearing loss, facial weakness, facial numbness, unsteadiness.
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