Hemifacial Spasm Overview:


  • Patients with hemifacial spasm experience intermittent, painless, spasm of muscles of the face, which is involuntary and limited to only one side.

  • The spasm and twitching may be limited to upper or lower half of the face only and eventually involve the entire half of the face.

  • This condition usually begins with rare twitching of muscles around one eye, and slowly progresses to involve the entire half of the face with increasing frequency and intensity.

  • In some cases patients may also experience excessive lacrimation.

  • Hemifacial spasm is commonly caused by compression of the facial nerve by AICA (anterior inferior cerebellar artery) at the root exit zone of the facial nerve.

  • Hemifacial spasm is generally a surgical condition with anticonvulsants such as carbamazepine and phenytoin being ineffective unlike trigeminal neuralgia.

  • Injection of the involved muscles with botulinum toxin may be effective in treating this disease temporarily.

  • Microvascular decompression of the facial nerve is the definitive treatment during which the offending vessel is dissected off the facial nerve and a thin strip of Teflon felt acts as a cushion between the facial nerve and the vessel compressing it.

  • The success of microvascular decompression does depend on the duration of the symptoms with shorter duration resulting in better outcomes.

  • The surgical technique of microvascular decompression (MVD) for hemifacial spasm is similar to MVD for trigeminal neuralgia.   Please look at the trigeminal neuralgia segment for more information about MVD.