Hemifacial Spasm

What is hemifacial spasm?

Hemifacial spasm is a cranial nerve disorder that causes involuntary twitching or contractions of the facial muscles on one side of your face. Typically, the spasm starts near your eye and progresses down your face. The twitching is not painful, but it can interfere with your normal expression and vision. It can be caused by a blood vessel or tumor compressing the nerve or an injury to the facial nerve. In some cases, there’s no obvious underlying cause. Any condition affecting the face can cause distress. AHN is here to help you find relief.

AHN Neuroscience

AHN Neuroscience is dedicated to providing highly specialized care for conditions affecting your brain, spine, and nervous system, offering solutions when other treatments aren't enough. Our expert neurosurgeons are not just performing procedures; they're dedicated to understanding your unique situation, carefully evaluating your symptoms, and working with you and your family to determine if surgery is the most effective path to improve your health and quality of life. We're here to guide you through every step, addressing your anxieties and ensuring you receive the most advanced and compassionate care tailored just for you.

Why choose AHN for your hemifacial spasm?

The experts at AHN Neuroscience perform pioneering treatments that provide relief from disorders like trigeminal neuralgia and hemifacial spasms. Our multidisciplinary program focuses on the treatment of cranial nerve disorders, providing you with comprehensive care that addresses your unique medical situation, pain, and psychological well-being. When you choose AHN for your hemifacial spasm, you can experience a:

• Multidisciplinary team of experts: You’ll benefit from a collaborative team of highly specialized professionals, including experienced neurologists, neurosurgeons, nurses, and physical therapists. This comprehensive approach ensures every aspect of your condition is thoroughly evaluated and addressed.
• Coordinated care model: We ensure seamless communication and integration across all specialties and services. From your initial diagnosis through ongoing treatment and support, our coordinated care model means you have a dedicated team working together, providing a clear path forward and eliminating fragmented care.
• Patient-centered care philosophy: Your well-being and quality of life are at the heart of everything we do. We prioritize understanding your personal challenges and goals, involving you in every decision, and empowering you with the knowledge and tools to effectively manage your condition.
• Advanced diagnostic and treatment technologies: Our center is equipped with state-of-the-art technology for precise diagnosis and effective treatment, including advanced neuroimaging, video-EEG monitoring, and access to the latest therapies.

Quick guide to hemifacial spasm

Hemifacial spasm symptoms and signs

Hemifacial spasm screening and diagnosis

Types and stages of hemifacial spasm

Hemifacial spasm treatment

Contact us

Hemifacial spasm symptoms and signs

Recognizing the early signs of a hemifacial spasm is key to finding relief. Hemifacial spasm symptoms typically affect only one side of the face and develop gradually. Common signs include:

• Involuntary face twitching or fluttering, usually starting in the eyelid.
• Twitching that slowly spreads down to the cheek, mouth, and neck on the same side.
• Facial twitching that can worsen with stress, fatigue, anxiety, or bright lights.
• Frequent facial spasms that may eventually become constant over time.

Causes and risk factors

To understand what triggers these facial spasms, looking closely at potential hemifacial spasm causes is essential. According to the National Library of Medicine, the overwhelming majority of cases, over 90%, are due to neurovascular compression. This means a blood vessel is pressing on the facial nerve (the seventh cranial nerve) as it exits the brainstem. While neurovascular compression is by far the most frequent reason, other underlying conditions can occasionally lead to these symptoms:

• Tumors: A noncancerous tumor (e.g., schwannoma, meningioma, epidermoid cyst) growing in the cerebellopontine angle (the area where the facial nerve exits the brainstem) can directly compress or irritate the facial nerve. Learn more about benign brain tumors.
• Aneurysms or arteriovenous malformations (AVMs): These are abnormal blood vessel structures that can also press on the facial nerve. Learn more about brain aneurysms and AVMs.
• Brainstem Lesions: Conditions that affect the brainstem, such as multiple sclerosis (MS) or stroke, can sometimes cause HFS-like symptoms due to damage to the facial nerve pathway within the brainstem.

Hemifacial spasm screening and diagnosis

An MRI scan may be ordered to rule out other conditions, such as a brain tumor, aneurysm, or arteriovenous malformation (AVM) that may be causing facial nerve compression. To rule out other conditions, your physician may recommend an electromyogram (EMG), which measures electrical activity in muscles at rest versus when they’re contracting. This is often accompanied by a nerve conduction velocity test, which measures how well and how fast your nerves send electric signals.

Types and stages of hemifacial spasm

Hemifacial spasm is a neurological condition characterized by frequent, involuntary muscle contractions or twitches on one side of the face. Hemifacial means half of the face, and a spasm is a muscle twitch. This condition is uncommon, and while it can affect both men and women, it is more prevalent in women aged 50–60. The types of hemifacial spasms are generally categorized into two main types depending on the underlying cause:

• Primary hemifacial spasm: This is the most common type, typically caused by a blood vessel pressing directly on the facial nerve near the brainstem, with no other underlying disease present.
• Secondary hemifacial spasm: This type occurs as a result of another distinct medical condition or structural issue affecting the nerve pathway, such as:
  • Brainstem lesions, such as those from multiple sclerosis or stroke
  • Arteriovenous malformations, aneurysms, or other arteriovenous issues
  • Rarely, benign tumors near the facial nerve.

Hemifacial spasms typically progress gradually over time, following a predictable pattern from mild twitches to more pronounced spasms:

• Initial stage: Spasms usually begin mildly and intermittently, most often starting as a subtle twitch in the eyelid or around the eye.
• Progressive stage: Over months or years, the twitches gradually spread downward to involve other muscles on the same side of the face, including the cheek, mouth, and jaw.
• Severe stage: In more advanced stages, the spasms can become nearly constant, causing the eye to clamp shut and the mouth to pull to one side, which may impact vision and daily activities.

Hemifacial spasm treatment

Our AHN neurosurgeons will work closely with you to determine the best treatment approach. Your plan may include:

• Medications: Anticonvulsant drugs may be all that’s required to block the nerve from firing. Muscle relaxants can also be effective.
• BOTOX®¹ injections: Botulinum toxin, or BOTOX, is a protein that causes muscle paralysis by blocking the electrical messages that tell the muscle to move. A very fine needle delivers injections into your facial muscles. It typically begins working within three days and lasts for three months. BOTOX injections can be repeated indefinitely, but the effectiveness diminishes over time.
• Microvascular decompression: This surgical procedure involves relocating or removing blood vessels that are in contact with the trigeminal root by placing a pad between the nerve and the arteries. Depending on the location of the blood vessel, this procedure may be able to be performed through an endoscope. Through tiny incisions, the surgeon uses the scope to deliver a sponge between the blood vessel and nerve to reduce pressure and stop the spasms.

Contact us

Call 412-359-8850 to schedule an appointment in Pittsburgh or learn more about hemifacial spasm treatment. For an appointment in Erie, please call 814-452-7575.