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What Is a Hemifacial Spasm?

A hemifacial spasm is a type of chronic neuromuscular condition that causes uncontrollable twitching of one, or more rarely both sides of the face. We offer diagnosis and treatment of hemifacial spasms at RWJBarnabas Health. Our board-certified neurologists and neurosurgeons are experts in brain and spinal cord function and have a high rate of success treating this condition.

A hemifacial spasm, also called tic convulsif, is a painless yet severe involuntary facial muscle twitch on one side of the face (“hemi-“ means “half”). These spasms are treatable. The condition typically affects the seventh cranial nerve pair that is responsible for the motor function of the eyebrows, eyes, mouth, and lips. They are much more common in middle-aged and elderly women and are found more frequently in those with Asian heritage. Nearly all hemifacial spasm patients have spasms that first begin near the eye region and then continue to progress down the face over time.

A hemifacial spasm is often caused by facial nerve injury, a tumor or blood vessel pushing against the nerve, or Bell’s palsy (paralysis of a portion of the face). Gradually, the continuous spasms may involve all muscles on one side of the face.

Symptoms of Hemifacial Spasm

Symptoms of a hemifacial spasm may include:

  • Facial tic
  • Balance problems
  • Fatigue
  • Nausea
  • Skin rash

Hemifacial Spasm Diagnosis

Once you see a doctor for a facial twitch, you may then be referred to a neurologist to diagnose hemifacial spasms. The neurologist can evaluate your brain function through a neurologic exam, and you’ll likely need a magnetic resonance imaging (MRI) scan to check for the presence of a tumor or blood vessel pushing against the seventh cranial nerve.

Hemifacial Spasm Treatment

While there is no surefire cure for hemifacial spasms, symptoms may be controlled with:

  • Medicine
  • Botox injections
  • Surgery

People with hemifacial spasms often find significant relief with a surgical solution. Surgery can relieve pressure on the facial nerve with a high success rate (about 85 percent), although the intervention does has significant potential side effects. For this reason, neurosurgeons carefully weigh the risks and benefits before recommending the operation.

Surgery for hemifacial spasms is called microvascular decompression, when an experienced neurosurgeon lifts a blood vessel off the nerve that it is compressing to relieve the pressure. Unlike injections of botulinum toxin (more commonly known as Botox), surgery is considered a permanent solution.

What to Expect During and After Microvascular Decompression Surgery for Hemifacial Spasms

Microvascular decompression is performed under general anesthesia. It begins with the neurosurgeon making a tiny incision behind a patient’s ear to access the skull through a small, one-inch opening. Because the surgeon can directly see the area where a small blood vessel presses on the patient’s facial nerve, the blood vessel can be lifted away from the nerve.

Sometimes there are multiple blood vessels pressing on the nerve, so it’s important that the neurosurgeon located and repair all of them to stop the spasms. A tiny pad is inserted to prevent further contact with the blood vessel before the neurosurgeon closes the incision.

Most patients recover quickly from microvascular decompression and can be released from the hospital two or three days after the surgery. Spasms often stop immediately, although other patients will continue to have spasms for about a week after the surgery is complete, and then they stop altogether.

When the surgery is successful, patients will have no further facial tics and require no further treatment.

Do You Have a Facial Twitch? Contact Us

Hemifacial spasms are more than a nuisance and can significantly impact your quality of life. Our specialists can help. You and your neurologist or neurosurgeon can discuss which treatment would be best for your hemifacial spasm. For more information, call Request an appointment with a neurosurgeon today.

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