Learn about getting a comprehensive orofacial pain evaluation and become an educated patient.
Hemifacial spasm (HFS) is a condition characterized by painless twitching of the muscles on one side of the face. The contractions are involuntary and occur in a “tonic-clonic” fashion, meaning the facial muscles either are fully tensed or alternate quickly between being tensed and relaxed. Those with HFS experience episodes of spasms, which typically last seconds to minutes. However, certain triggers can cause these episodes to occur more often or can worsen their severity. These triggers include psychological factors (anxiety, stress, fatigue, and sleep deprivation) and physical factors (reading, chewing, specific head positions, and light exposure).
These spasms initially affect the nerves near the eye, which causes rapid eyelid closing and eyebrow raising, and expands over time to include all the face muscles. In the most severe form, HFS can cause a prolonged spasm with one eye completely shut and one half of the face fully contracted. These symptoms usually only occur on one side of the face, with only 0.5-6% of patients having HFS on both sides. Something unique about HFS, compared to most other conditions affecting muscles, is that the contractions can occur even during sleep. Over the course of years, the symptoms usually worsen. However, about 10% of patients can spontaneously recover.
Hemifacial spasm is a fairly rare condition, with a worldwide prevalence of 9.8-11 per 100,000. Women are affected about twice as often as men are. In cases of primary HFS, symptoms usually begin between 40 to 60 years, and only 1-6% of those with HFS have symptoms before the age of 30. Researchers have not found a genetic link for HFS, meaning it does not run in families.
The facial nerve, responsible for moving most of the muscles in the face, is affected in HFS. Most commonly, in primary HFS, a small blood vessel compresses the facial nerve at the brainstem, which is near the back of the neck. This compression irritates the nerve and causes it to malfunction. The secondary type of HFS usually occurs after a facial palsy, or when the face muscles become weak or paralyzed. Rarely, this type of HFS occurs due to other forms of compression, such as cysts, aneurysms, tumors, or arteriovenous malformations, infection, and multiple sclerosis.
A doctor, usually a neurologist or neurosurgeon, can diagnose HFS by taking a detailed history of the patient’s symptoms. Sometimes, physicians may perform maneuvers that can trigger the repetitive facial spasms. Other tools to help diagnose hemifacial spasm are electromyography (EMG) and MRI of the brain. An EMG has a specific pattern that may indicate damage to the nerve, and an MRI scan can show if a blood vessel or other mass is compressing the facial nerve. While an MRI or EMG can help confirm the cause of HFS, these tests are not needed for a doctor to diagnose the condition.
Treatments for primary hemifacial spasm include oral medications, botulinum toxin injections, and surgery.
Doctors manage patients with secondary HFS by treating the underlying cause. For example, patients that have HFS due to a large tumor may choose to undergo chemotherapy or surgery.
Blitzer, Andrea L., and Paul O. Phelps. “Facial Spasms.” Disease-a-Month: DM 66, no. 10 (October 2020): 101041. https://doi.org/10.1016/j.disamonth.2020.101041.
Chaudhry, Neera, Abhilekh Srivastava, and Laxmikant Joshi. “Hemifacial Spasm: The Past, Present and Future.” Journal of the Neurological Sciences 356, no. 1 (September 15, 2015): 27–31. https://doi.org/10.1016/j.jns.2015.06.032.
Chopade, Tripti R., and Pradeep C. Bollu. “Hemifacial Spasm.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/NBK526108/.
Kong, Doo-Sik, and Kwan Park. “Hemifacial Spasm: A Neurosurgical Perspective.” Journal of Korean Neurosurgical Society 42, no. 5 (November 2007): 355–62. https://doi.org/10.3340/jkns.2007.42.5.355.
Lefaucheur, J. -P., N. Ben Daamer, S. Sangla, and C. Le Guerinel. “Diagnosis of Primary Hemifacial Spasm.” Neurochirurgie, Hemifacial Spasm: a neurosurgical disease, 64, no. 2 (May 1, 2018): 82–86. https://doi.org/10.1016/j.neuchi.2017.12.003.
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