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What Are Hemifacial Spasms?

Hemifacial spasms are a neurological disorder that manifests as involuntary muscle contractions on one side of the face. Typically, it begins around the eye, causing rapid and repetitive twitching, and can progressively involve other facial muscles. This condition is primarily caused by compression or irritation of the facial nerve, leading to misfiring signals to the affected muscles. Although not life-threatening, hemifacial spasms can cause significant discomfort and social embarrassment and interfere with daily life.

Possible Symptoms of Hemifacial Spasms:

  • Involuntary muscle contractions on one side of the face
  • Rapid and repetitive twitching, typically around the eye
  • Unilateral (affecting only one side)
  • Discomfort and facial distortion
  • Social embarrassment
  • Interference with daily activities

Potential Causes of Hemifacial Spasms:

  • Compression or irritation of the facial nerve
  • Blood vessel abnormalities or pressure on the facial nerve
  • Neurological conditions like multiple sclerosis
  • Tumors or lesions affecting the facial nerve
  • Idiopathic (unknown cause in some cases)

Treatment Options for Hemifacial Spasms

Botulinum Toxin Injections
Botulinum toxin injections, such as Botox, are widely used non-surgical treatments for hemifacial spasms. These injections contain a highly purified form of botulinum toxin, a potent neurotoxin produced by the bacterium Clostridium botulinum. When administered for hemifacial spasms, botulinum toxin is carefully injected into the affected facial muscles.

The toxin blocks the release of acetylcholine, a neurotransmitter responsible for muscle contraction, at the neuromuscular junctions. By inhibiting this communication, the muscle contractions are significantly reduced, alleviating the involuntary spasms and twitching associated with hemifacial spasms. The effects of Botox injections are temporary and typically last for a few months, after which the procedure may need to be repeated.

Microvascular Decompression Surgery (MVD)
Microvascular decompression surgery is a surgical procedure that alleviates the compression of the facial nerve by surrounding blood vessels or structures. During the procedure, the surgeon makes a small incision behind the ear on the affected side of the face and creates a small opening in the skull. The surgeon uses precise surgical techniques and microscopic visualization to identify the offending blood vessels or structures compressing the facial nerve.

The blood vessels responsible for the spasms are carefully repositioned or padded with a soft cushion-like material like Teflon to alleviate the pressure on the nerve. Once the compression is relieved, the incision is closed, and the patient is monitored during recovery. Microvascular decompression surgery is considered an effective and long-lasting treatment for hemifacial spasms because it addresses the root cause of the involuntary spasms.

Selective Neurotomy
Selective neurotomy is a surgical procedure used when treatments like Botox don’t work or when microvascular decompression surgery is not feasible or carries too high a risk due to patient-specific factors. It involves the selective removal or cutting of specific nerve fibers responsible for the involuntary muscle contractions associated with the condition, thereby addressing one of the structural root causes of the condition.

During the procedure, the surgeon identifies the nerves responsible for the spasms, often using advanced imaging techniques to pinpoint the precise location. Once identified, these nerves are carefully cut or partially removed, interrupting the signals that trigger the muscle contractions. This disruption in nerve communication alleviates the spasms on the affected side of the face. Selective neurotomy can offer long-lasting relief from hemifacial spasms.

Schedule An Appointment

Dr. Lekovic is a board-certified neurosurgeon with specialized expertise in skull base and cerebrovascular surgery, boasting a remarkable career spanning over two decades. If you or a loved one is seeking guidance or treatment for neurological conditions like hemifacial spasms, we encourage you to take the next step toward relief. Schedule an appointment to consult with Dr. Lekovic, who can explore the best treatment options tailored to your needs.

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