Hemifacial Spasm vs. Blepharospasm: What’s the Difference?

Involuntary spasms and movements that affect parts of your face can be indicative of underlying medical conditions like hemifacial spasms and blepharospasm. Both conditions involve involuntary muscle contractions, but they affect different areas of the face and have unique underlying causes and symptoms. Patients often confuse one for the other because of their similarities, but it’s important to be aware of their differences. So, what’s the difference between hemifacial spasms and blepharospasm?

What is Hemifacial Spasm?
Hemifacial spasm is a neurological disorder characterized by involuntary muscle contractions on one side of the face. Typically, it begins with twitching around the eye and can gradually progress to other facial muscles. This condition is often caused by irritation or compression of the facial nerve, which controls facial movements. Although not life-threatening, hemifacial spasm can lead to social and emotional challenges associated with visible facial twitching.

What is Blepharospasm?
Blepharospasm is a neurological disorder characterized by repetitive and uncontrollable blinking or spasms of the eyelids. This condition can cause excessive blinking, eye closure, or even forced closure of both eyes, leading to temporary vision impairment. While the exact cause is often unknown, it is thought to involve abnormal brain signaling. Blepharospasm can interfere with your daily activities like reading or driving and can be socially distressing.

Symptoms of Hemifacial Spasm:

• Involuntary twitching on one side of the face
• Initial onset often around the eye area
• Progression to other facial muscles over time
• Intermittent spasms that can increase in frequency
• Discomfort or tightness in affected muscles
• Disturbance in daily activities and social interactions
• Auditory symptoms like tinnitus (rare)

Symptoms of Blepharospasm:

• Involuntary blinking or eyelid spasms
• Increased frequency of blinking
• Difficulty keeping the eyes open
• Eye irritation or dryness
• Sensitivity to light
• Facial spasms extending beyond the eyelids
• Discomfort around the eyes
• Functional blindness in severe cases

Causes of Hemifacial Spasm:

• Compression or irritation of the facial nerve by blood vessels.
• Blood vessels pressing against the facial nerve.
• Structural abnormalities like tumors or cysts within the brain or facial region.
• Aberrant regeneration of the facial nerve post Bell’s Palsy, leading to misfiring and spasms.
• Rarely, benign or malignant tumors can compress the facial nerve.
• In some cases, individuals may have a genetic predisposition to hemifacial spasms.

Causes of Blepharospasm:

• The basal ganglion, which controls muscle movements, might send incorrect signals.
• Prolonged eye irritation or inflammation from environmental factors like dust or dye eye.
• Genetic predisposition or familial occurrence can increase the risk of blepharospasm.
• Exposure to certain drugs or medications that affect neurotransmitters.
• Surgeries or trauma can damage the nerves or muscles around the eyes, causing spasms.
• Underlying neurological disorders like Parkinson’s disease or dystonia.
• Prolonged periods of stress or lack of rest can exacerbate or trigger blepharospasm.
• For some patients, the exact cause of blepharospasm remains unknown.

Treatments for Hemifacial Spasm
One of the most common and effective treatments for hemifacial spasms involves the injection of botulinum toxin, commonly known as Botox. These injections temporarily paralyze the affected muscles, providing relief from the involuntary spasms. The effects are temporary, requiring periodic touch-ups every 3 to 4 months, but most patients find considerable relief.

For those seeking a more permanent solution or for whom Botox is ineffective, microvascular decompression surgery is an option. This procedure addresses the root cause by relieving the pressure on the facial nerve, often caused by blood vessels. By repositioning or cushioning these vessels, the surgery can provide long-term relief from the spasms.

Treatments for Blepharospasm
The least invasive treatments for blepharospasms include botulinum toxin injections, such as Botox or Xeomin. By targeting the specific muscles causing the spasms, these injections can reduce or even halt the involuntary blinking, providing patients with a reprieve from the condition. However, the effects only last 3 to 4 months, necessitating periodic touch-ups.

For individuals seeking alternative treatments or those who don’t respond well to injections, oral medications are another option. In more severe cases, a surgical procedure called myectomy might be considered. This surgery involves removing some of the muscles or nerves in the eyelid to reduce or eliminate the source of spasms, providing long-lasting relief.

Distinguishing between hemifacial spasms and blepharospasms can be difficult, even if you have all the information. If you or a loved one is experiencing the symptoms of either of these conditions, seeking expert guidance is crucial.

Dr. Gregory Lekovic, with his extensive experience and dedication to neurosurgery, offers comprehensive evaluations and cutting-edge treatments. Renowned internationally for his expertise, Dr. Lekovic ensures personalized care tailored to each patient’s needs. Don’t let these conditions affect your quality of life; reach out for a consultation today.