Have you ever noticed someone with a facial twitch that affects only half of their face? It looks as if they are about to sneeze, and one half of the face contorts suddenly? Its almost as if its not in their control at all? And it keeps happening over and over again?

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Hemi Facial Spasm

 Hemifacial spasm is a condition that an oculoplastic surgeon sees very commonly in his or her clinic. Hemi-facial spasm is involuntary twitching or contraction of most of the facial muscles on one side of the face.

 

What causes it ?

All the muscles that twitch are innervated or supplied by the same nerve – the facial nerve. The facial nerve originates in the brain and travels across from behind the ear, in close relation to the salivary gland and then supplies all the muscles of the face. This is the same nerve that helps you smile, pout and whistle! But when inflammed, traumatised, under pressure or damaged; this nerve can misfire and send out intermittent impulses which in turn causes involuntary spasms across one side of the face; right from the forehead right upto the neck muscles. Sometimes, a stroke or an infection may also cause it. However in a substantial proportion of patients, there may not be any identifiable cause and these cases of hemifacial spasm are often referred to as ‘idiopathic’ cases.

 

Can it be treated?

Yes, there are different options available for the treatment of HFS. But before starting treatment, it is possible that your doctor may request a few investigations such as an MRI (Magnetic Resonance Imaging) and an EMG (electromyography)

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Are there any medicines that can prevent Hemifacial Spasm?

Some medicines such as carbamazepine, benzodiazepines and muscle relaxants which may be used early on in the course of the disease or in situations when the patient refuses the option of botulinum toxin injection. Pharmacological therapy or medicines have not been as effective as Botulinum Toxin-A (Botox) in the resolution of symptoms. What about surgery? In case there is documented compression over the nerve, then decompression surgery may be advised. Sometimes, some dilated blood vessels can cause hemifacial spasm by compressing the facial nerve as it leaves the brainstem. Surgical decompression of these blood vessels may give good results.

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Benign Essential Blepharospasm:

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Benign Essential Blepharospasm is a rare neurological disorder in which affected individuals experience involuntary muscle spasms and contractions of the muscles around the eyes. This condition is a type of dystonia, which is a group of movement disorders involving uncontrolled tensing of the muscles (muscle contractions), rhythmic shaking (tremors), and other involuntary movements.

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Patients of this condition find it difficult to open their eyes and keep them open for long. 

 

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What are the treatment options?

After having ruled out any mass lesion causing compressive neuropathy; the first line of treatment for both hemifacial spasm and Blepharospasm is Botulinum Toxin injection. Botox, as it is commonly known is injected into the affected muscles after isolating the muscles affected. One may require upto 35 units of Botox. It is usually a short procedure which takes no longer than 10 minutes. The maximal effect of the injection is seen a few days after the injection. Botox works by relaxing and weakening the facial muscles and preventing spasms from occurring. The effect of this Botox may last for upto 3-4 months and varies from person to person. On an average, a patient requires 2-3 injections per year.

 

Some recent studies have demonstrated that with multiple treatments the effect lasts longer, thereby requiring less frequent treatments as time goes by. 

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Why an ophthalmologist?

Oculoplastic surgeons are ophthalmologists who have specialised in the branch that deals with the eyelids, the facial anatomy and the conditions such as Hemifacial spasm and blepharospasm are best treated by them. These spasms can be troublesome, embarrassing conditions which can be controlled if diagnosed and treated correctly