Hemifacial spasm is a condition that can occur due to uncontrollable twitching of the muscles on one side of the face, especially when stressed or excited. It is most commonly seen in middle-aged individuals. Once it occurs, it may lead to loss of confidence and anxiety, so it is advisable to see a doctor for treatment promptly.

Understanding Hemifacial Muscle Spasm

Hemifacial muscle spasm usually begins with slight twitching of the muscles around the eyes or cheek in the early stages. In medical terms, it is necessary to differentiate from other conditions of facial muscle spasms such as:

1. Eyelid Myokymia
2. Blepharospasm
3. Hemifacial Spasm

The differences in symptoms among the three conditions can be categorized as follows:

What is Hemifacial Spasm

Hemifacial Spasm (HFS) is a neurological condition causing involuntary contractions or spasms of the facial muscles. It occurs on one side of the face, starting from mild to severe twitches, typically beginning around the eyelid of the affected side and spreading to the lower facial muscles. In severe cases, contractions may cause permanent muscle stiffness, inability to open the eye, and distortion at the corner of the mouth. It is more common in women than men.

Causes of Hemifacial Spasm

Causes of Hemifacial Spasm include compression of the facial nerve (Cranial Nerve VII) by blood vessels in the brain, responsible for facial muscle control around the eyes, forehead, mouth corners, and superficial muscles in the neck. The condition and its duration cannot be controlled and may also result from accidents damaging the nerve, tumors pressing on the nerve area, or unknown causes in some patients.

What are the Symptoms of Hemifacial Spasm

• Mild twitching around the eyes
• Involuntary blinking or eyelid closure
• Twitching at the corner of the mouth
• Narrowed or squinted eyes
• Intermittent mouth distortion

Characteristics of Hemifacial Spasm

• Intermittent twitching
• Irregular twitching
• Unrhythmic twitching
• Twitching with muscle contraction
• Twitching with abnormal facial muscle movements (Facial Synkinesia)

Diagnosis of Hemifacial Spasm

• Medical history and examination by a brain and neurological specialist
• MRI (Magnetic Resonance Imaging) scans to consider lesions on the nerve or brainstem

Treatment Methods for Hemifacial Spasm

The treatment methods for Hemifacial Spasm are divided into three main ways:

1. Medication focuses on symptomatic relief with muscle relaxants prescribed for continuous use under medical guidance. It may cause drowsiness and have side effects, and the condition could recur after the medication wears off.
2. Botulinum Toxin (Botox) Injections are used to reduce twitching by direct administration to twitching muscles. Though effective, they require repeat injections every 3 – 4 months as advised by a doctor, with regular follow-up appointments to monitor symptoms. It is crucial to receive treatment from a specialist to minimize risks, such as facial muscle weakness, asymmetric face, and incomplete eyelid closure.
3. Microvascular Decompression (MVD) Surgery is recommended when blood vessels press against the facial nerve. A specialist performs surgery using a microscope to separate vessels from the 7th cranial nerve at the brainstem. This method addresses the root cause, with direct nerve decompression resulting in minimal scars, less pain, fast recovery, and permanent twitch cessation.

Risk Factors for Hemifacial Spasm

• Stress, anxiety, irritability, anger
• Excessive facial muscle movements like smiling, speaking, eye usage, etc.
• Lack of sleep, fatigue, prolonged insufficient rest

Although hemifacial spasm is not critically severe like paralysis, some patients may not fully recover, often experiencing recurrent symptoms that affect confidence and daily life. Thus, consulting a doctor for ongoing treatment is advised to reduce the severity and enhance long-term quality of life.

Specialists in Hemifacial Spasm Treatment

Maj. Gen. Dr. Siraruj Sakoolnamarka, a brain and neurological surgeon, is specialized in treating hemifacial spasm at Bangkok International Hospital, a facility for brain and orthopedic health.

You can click here to schedule an appointment on your own.

Hospitals Specialized in Hemifacial Spasm Treatment

The Brain and Orthopedic Hospital offers guidance, diagnostics, and hemifacial spasm treatment with a specialized team of brain physicians, nurses, and multidisciplinary team members, using modern technology to reduce severity and help patients regain their self-confidence.