Treatment Options for Hemifacial Spasms

By Elizabeth Stannard Gromisch HERWriter

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About 15 in every 100,000 women have hemifacial spasms, a condition in which the patient has frequent and involuntary contractions of the facial muscles, according to the University of Maryland Medical School. With a hemifacial spasm, the muscle contractions occur on only one side of the face.

Both women and men can have this neuromuscular condition, though women have it more often. Patients begin having symptoms of this disorder in their 40s.

To diagnose hemifacial spasms, a physician will conduct a neurological exam. Different scans may be ordered to rule out conditions that can cause these symptoms.

For example, a doctor may order a magnetic resonance imaging (MRI) scan to see if the facial spasms are caused by a tumor or a brain aneurysm. Another test that may be done is an electromyogram, or EMG.

An EMG measures the electrical activity of the muscles, both when they are at rest and when they are contracted. The Mayfield Clinic noted that in many cases, an EMG is done with a nerve conduction velocity (NCV) study to test electrical activity of both the muscles and nerves.

Several treatment options are available for hemifacial spasms. One option is medication, such as anticonvulsant drugs, which interfere in the nerve’s firing of electrical signals.

Examples of anticonvulsant drugs used for hemifacial spasms include phenytoin and carbamazepine. Another medication option is muscle relaxants, such as clonazepam, baclofen and diazepam.

The Mayfield Clinic stated that the latter group of drugs can help with mild cases of hemifacial spasms, but can cause side effects such as dependence, drowsiness, nausea, unsteadiness and skin rashes.

The National Institute of Neurological Disorders and Stroke noted that the most effective treatment for hemifacial spasms is botulinum toxin injections. Botulinum toxin, also called Botox, works by paralyzing the muscle by blocking release of the neurotransmitter acetylcholine. If the muscle does not receive acetylcholine, it does not receive the message to move.

In the treatment of hemifacial spasms, Botox is given to the patient in one to three injections. The effects start within three days and can last up to three months, though the effectiveness diminishes over years of use, according to the Mayfield Clinic.

For some patients, Botox and medications do not alleviate the symptoms, so surgery is need. The type of surgery used for hemifacial spasms is called microvascular decompression. In this procedure, the surgeon relieves compression on the facial nerve by placing a Teflon sponge between the nerve and the blood vessel putting pressure on it.

With this surgery, 85 percent of patients have immediate relief, 9 percent have diminished symptoms, 2 percent have a delay in having facial spasms, and 7 percent have a recurrence of symptoms, noted the Mayfield Clinic. Side effects can occur with this surgery, including facial weakness and decreased hearing.

References

University of Maryland Medical Center. Hemifacial Spasm. Web. 5 December 2011
http://www.umm.edu/neurosciences/hem_spasm.htm

National Institute of Neurological Disorders and Stroke. Hemifacial Spasm Information Page. Web. 5 December 2011
http://www.ninds.nih.gov/disorders/hemifacial_spasm/hemifacial_spasm.htm

Mayfield Clinic. Hemifacial Spasm. Web. 5 December 2011
http://www.mayfieldclinic.com/PE-HFS.htm

University of Florida Department of Neurosurgery. Hemifacial Spasm. Web. 5 December 2011
http://www.neurosurgery.ufl.edu/patients/hemifacial-spasm.shtml

Reviewed December 6, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.