Hemifacial spasm (HFS) is an involuntary twitching or contraction of the facial muscles on one side of the face. Medication, surgery, and Botox injections are treatment alternatives to stop the spasms and relieve the pain. Each treatment provides benefits, but each has limitations. You and your doctor must identify which treatment is best.
What is hemifacial spasm?
Hemifacial spasm (likewise called tic convulsif) is an involuntary twitching of the facial muscles on one side of the face. The facial muscles are controlled by the facial nerve (seventh cranial nerve), which originates at the brainstem and exits the skull below the ear where it separates into five main branches (Fig. 1). The facial nerve is primarily a motor nerve, implying it controls muscles that move the eyebrows, close the eyes, and move the mouth and lips.
The facial nerve (7th cranial nerve) comes from the brainstem and exits the skull below the ear where it has five main branches that manage the muscles of facial expression.
What are the symptoms?
Hemifacial spasm are seldom discovered by others right from the start. It’s a condition that establishes really progressively, and at first it does not include more than a little jerk that is seldom seen or considered noteworthy. It normally starts with a little twitching in the eyelid muscle that reoccurs.
If hemifacial spasm symptom goes on, it then has the tendency to spread to some muscles on the bottom part of the face, around the jaw and the mouth to be more particular. What might be observed in this stage is an intermittent moving of the jaw bone to one or either side. People have actually also reported to experience some sort of snapping sound inside the ear due to the jaw movement each time a muscle spasms happens.
Statistically, this condition is understood to have predominance on the left side of the face. Also, even though it may not have sounded to fretting at first, this whole twitching can develop to the point where it may involve all or practically all the muscles on one side of the face, and the twitching may happen continuously.
What causes hemifacial spasm?
Hemifacial spasm can be brought on by injury to the facial nerve, a tumor or blood vessel compressing the nerve, or Bell’s palsy. The most typical cause is compression of your facial nerve by the anterior inferior cerebellar artery where the nerve starts at your brainstem. The compression causes the nerve to misfire making your facial muscles agreement. This condition belongs to trigeminal neuralgia– an irritation of the fifth cranial nerve that causes severe facial pain. Both hemifacial spasm and trigeminal neuralgia are caused by nerve compression from a blood vessel, yet differ in whether the sensory nerve or motor nerve is compressed.
Who is affected?
Hemifacial spasm is unusual, impacting just 8 people in 100,000 in the US. The typical age of beginning is 44 years and takes place a little more in women.
How is a medical diagnosis made?
First, your doctor will thoroughly review your medical history and perform a neurological examination. An MRI scan might be bought to rule out other conditions such as a brain growth, aneurysm, or AVM that may be causing facial nerve compression. Next, you may have an electromyogram (EMG) research study of the face. An EMG is often done along with a nerve conduction speed (NCV) study to measure your muscle and nerve electrical activity.
A number of treatments have been developed against this twitching condition. Here, we have listed the 3 hemifacial spasm treatments that are generally related to by the scientific community to be best and more reliable for the patient.
Your doctor might recommend anti-convulsant drugs such as carbamazepine (Tegretol) or phenytoin (Dilantin) to block firing of the nerve. Muscle relaxants such as baclofen (Lioresal), diazepam (Valium), and clonazepam (Klonopin) may likewise be prescribed. These drugs can be successful in dealing with moderate cases but trigger side effects (e.g., sleepiness, unsteadiness, nausea, skin rash, reliance). For that reason, patients are kept an eye on consistently and go through blood tests to ensure that drug levels continue to be safe which the patient doesn’t develop blood disorders.
Botox injections for Hemifacial Spasm
Botulinum toxin, or Botox, is a protein produced by the C. botulinum bacteria that cause muscle paralysis by obstructing the electrical messages that “inform” the muscle to move. Messages are brought by a neurotransmitter called acetycholine. Botox obstructs the release of acetycholine; as a result, the muscle doesn’t receive the message to contract. A very fine needle is used to deliver 1 to 3 injections into your facial muscles. Your doctor will choose which muscles. Botox typically works within three days and usually lasts for three months. Botox injections can be restarted indefinitely, nevertheless the efficiency diminishes throughout the years due to the accumulation of antibodies. Side effects consist of temporary facial weak point, sagging eyelid, eye irritation and level of sensitivity.
Medications and injections sometimes fail to manage spasms or trigger side effects. A treatment, called microvascular decompression, can alleviate the nerve compression. A neurosurgeon makes a hole in the bone (craniotomy) at the back of your visit expose the facial nerve at the brainstem. A Teflon sponge is placed in between the offending blood vessel and the facial nerve.
Hemifacial spasm is usually caused by an artery compressing the facial nerve. Throughout surgery, a sponge is placed in between the artery and the nerve to ease the pressure and stop the facial muscle spasms.
About 90 % of patients return to their routine lifestyle after 2 months. Like all surgeries, there are threats. More regular side effects include reduced hearing and facial weakness. Your surgeon will use intra-operative monitoring of the 7th (facial) and 8th (hearing) nerves during surgery to decrease these problems. In 90 % of surgical cases there seems a blood vessel compressing the nerve. In general, results of surgery consisting of:
- 85 % experience immediate relief from spasms.
- 9 % credit report diminished spasms.
- 2 % file hold-up in facial spasm in the month following surgery.
- 7 % experience a reoccurrence of spasms after surgery.