HEMIFACIAL SPASM
Philip A. Hanna, M.D.
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
Hemifacial spasm (HFS) is a condition in which there are involuntary,
brief contractions of the muscles on one side of the face. The muscles
around the eye are typically involved first which may then spread to
involve muscles near the mouth and lower face. Pursing of lips,
whistling, closing one's eyes, fatigue and stress may aggravate these
spasms. If severe, vision may be affected secondary to eyelid closure
on the affected side, and HFS can be socially impairing. The
prevalence of HFS has been estimated at 1/1000, is more common in
women and in Asian populations. Rarely, both sides of the face may be
affected but the contractions on the two sides are independent of each
other.
HFS is most commonly secondary to compression of the facial nerve near
the exit of this nerve from the brainstem. This compression is usually
by a small blood vessel near the base of the brain. Less commonly,
brain tumors, aneurysms or trauma can result in compression of this
nerve. If atypical features are present, such as numbness of the
affected side of the face or hearing loss, an MRI may be useful as
part of the evaluation.
With regards to medications, although a number have been used for this
condition, they are rarely helpful. Surgery is available to relieve
the compression of the seventh nerve. This procedure, in a small
number of cases, can result in facial weakness, deafness or stroke.
Thus, many physicians prefer the use of botulinum toxin injections as
the initial treatment. Using relatively low doses, the excess
contractions are reduced without creating facial weakness. The benefit
lasts 4-6 months on average, and typically begin to take effect after
3-7 days. The procedure is usually well tolerated with potential side
effects of eyelid drooping or facial weakness but these are typically
mild and transient.
Tan EK, Jankovic J. Bilateral Hemifacial Spasm: A Report of Five Cases
and a Literature Review. Mov Disord;14:345-349.
Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment.
Muscle Nerve 1998;21:1740-1747.
Wirtschafter JD, Rubenfeld M. Botulinum toxin injections for treatment
of blepharospasm and hemifacial spasm. International Ophthalmology
Clinics 1991;31:117-132.
 | ||||||||||||
 |
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
|
|
|||||||||||||||||||||||||||||||