Hemifacial Spasm

A blood vessel irritating the facial nerve

Hemifacial spasm is intermittent, painless, involuntary twitching of the muscles on one side of the face. It often begins around the eye and can spread to the rest of that side of the face over time. The usual cause is a blood vessel resting against the facial nerve where it leaves the brainstem, irritating it. It is one of the few movement disorders that continues even during sleep, which helps distinguish it from other facial movements.

For lasting relief beyond injections

Botulinum toxin injections relieve the spasm temporarily and are a good non-surgical option, but they must be repeated. Surgery is considered for definitive, lasting treatment, particularly when injections are no longer satisfactory or the patient prefers to address the underlying cause.

Treatment options

• Microvascular decompression (MVD)
  An operation that reaches the facial nerve where it leaves the brainstem and moves the offending blood vessel away, placing a soft cushion between them. Because it treats the cause, it offers durable relief, with high success rates in experienced hands. The main specific risk to be aware of is some hearing loss on the treated side, which is why the procedure is best done in centers experienced with it.
• Botulinum toxin (non-surgical)
  Targeted injections that weaken the twitching muscles and relieve the spasm for several months at a time. A repeatable option for those who prefer to avoid surgery.

See also