Hemifacial Spasm

Diagnosis

Diagnosing hemifacial spasm usually begins with a thorough review of your medical history and symptoms. Your healthcare professional will ask how long you have experienced muscle twitching and whether the spasms affect one or both sides of the face. A detailed physical and neurological examination is performed to assess muscle movement and nerve function.

Imaging tests may be recommended to confirm the cause, including:

• Magnetic resonance imaging (MRI): Creates detailed images of the head and can show if a blood vessel is pressing on the facial nerve or if a tumor or other brain condition is present.

• Magnetic resonance angiography (MRA): Involves using a special dye to highlight blood vessels and reveal contact between a vessel and the facial nerve.

• Electromyography (EMG): Measures electrical activity in facial muscles to determine if the nerves and muscles are communicating properly. EMG is not always necessary but may be used for more complex cases.

Imaging tests are typically recommended when symptoms are unusual or if surgery is being considered.

Treatment

Treatment for hemifacial spasm focuses on relieving muscle contractions and improving quality of life. Depending on the severity, options may include:

• Oral medicines: Antiseizure drugs and muscle relaxants may reduce spasms in mild or early stages of the condition.

• OnabotulinumtoxinA injections (Botox): Injections into the affected facial muscles block nerve signals that cause spasms. The treatment must be repeated every few months and is effective for most people.

• Surgery:

  • Microvascular decompression (MVD): The most effective long-term surgical option. The surgeon makes an incision behind the ear and places a small spongelike pad between the blood vessel and the facial nerve to relieve pressure.

  • Other surgical techniques: Procedures such as nerve massage, heat therapy, or electrical pulses can reduce nerve sensitivity. In some cases, part of the facial nerve may be cut or treated with radiofrequency thermocoagulation to stop abnormal signals.

• Acupuncture: Some research suggests acupuncture may help manage hemifacial spasm symptoms, although more studies are needed to confirm its effectiveness.

Early diagnosis and appropriate treatment can help manage symptoms effectively and improve facial comfort and function.