Hemifacial Spasms

Hemifacial Spasms

Generally a benign condition

Unilateral , involuntary , irregular tonic or clonic contractions of muscles supplied by the facial nerve. More common in women than men and  age at onset 5th to 6 th decades but may occur earlier. 

Examination usually normal , occasionally very subtle facial weakness may be seen. Any associated weakness , deafness , ataxia , facial sensory impairment dictates that investigations for a  cause should be vigorously pursued .

Rarely hemifacial spasms may at times be associated with trigeminal neuralgia and then the pain and spasm paroxysms seem to occur independently.


 

Causes

1 Extrinsic compression of the root entry zone by vascular structures

2 Tumours of the CP angle

3 Secondary – partial recovery from Bells palsy or trauma

Treatment

1 Botulinus toxin injection – may need to be given every several months

2 Carbamazepine , Gabapentin , Clonazepam and Baclofen may or may not work

3 Micro vascular decompression of the facial nerve – can be done but has associated risks of deafness and facial weakness