Treatment options for hemifacial spasm

September 9, 2014 Dean Hamilton, ARNP

Hemifacial spasm is the involuntary contractions of the muscles of the face, those innervated by the facial nerve (VII). The facial spasms are intermittent and occur on one side of the face only. Hemifacial spasm can involve the upper or lower half of the face and may progress to involve the entire half of the face. The intensity and frequency of these symptoms can increase over time and can persist even during sleep. Hemifacial spasm can be associated with vestibular dysfunction and cochlear dysfunction.

Hemifacial spasm is usually more common in women. The most common cause of hemifacial spasm is compression of the facial nerve by a blood vessel, usually an artery, most often the anterior inferior cerebellar artery (AICA). Compression of the facial nerve may also be caused by the posterior inferior cerebellar artery (PICA), superior cerebellar artery (SCA), cochlear artery, and dilation or distortion of the basilar artery.  Hemifacial spasm can also be caused by tumors, cysts, and in some cases, deformities of the skull however; these are less common than vascular compression.  Hemifacial spasm can also occur after Bell’s palsy.  Your physician may order diagnostic studies such as an MRI of the brain or head CT to further evaluate the causes of hemifacial spasm; however, in most cases, these studies are negative.

In terms of management, medications are usually not effective in the management of hemifacial spasm.  Botox injections may be helpful.  The surgical procedure of choice is called microvascular decompression or MVD which addresses the most common cause of hemifacial spasm, compression of the facial nerve by a blood vessel.  Treatment options for hemifacial spasm are available at Swedish Neuroscience Institute including botox and microvascular decompression.

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