Hemifacial Spasm

When it comes to identifying types of pain, there are two types: acute and chronic. Acute pain comes on quickly, can be severe but only lasts a relatively short time. It is typically experienced after an injury or trauma, and self-resolves.

Unlike acute pain, chronic pain is pain that lasts for a long time, and doesn't seem to get better or go away. This time period can vary but is typically defined as a three- to six-month period after symptoms begin. Chronic pain is often a debilitating symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. Chronic pain is a frequent component of many neurological disorders.

Pain warns you that something is not quite right in your body and can cause you to take certain actions and avoid others. Pain can significantly affect your quality of life—by adversely affecting your physical and emotional well-being; upsetting relationships with family, coworkers and friends; and limiting your mobility and participation in daily activities.

Hundreds of pain syndromes or disorders make up the spectrum of pain. One cause of pain are cranial neuralgias (CNs), which are syndromes caused by disruption or damage to the nervous system including the peripheral nerves, spinal cord and brain. These conditions cause sudden attacks of stabbing, sharp, pain around the face and head called paroxysms. There are three common types of CNs: trigeminal neuralgia, glossopharyngeal neuralgia and hemifacial spasm.

Hemifacial spasm is a neuromuscular disorder involving frequent contractions or spasms of the muscles on one side of the face. The spasms are involuntary, meaning they happen on their own without trying. The disorder occurs in both men and women, yet it is more common in middle-aged or older women. It is also much more common in the Asian population.

The disorder occurs in both men and women, yet it is more common in middle-aged or older women. It is also much more common in the Asian population.

Those with trauma, Bell’s palsy, brainstem lesions (those associated with multiple sclerosis and stroke), Chiari malformation and intracranial arterial aneurysms are at higher risk of hemifacial spasms. The symptoms of this chronic neuromuscular condition can be reduced by:

• Managing anxiety and stress
• Reducing or eliminating stimulants, such as caffeine
• Avoiding fatigue
• Increasing intake of vitamin D

The first symptom of hemifacial spasm is usually twitching of the eyelid muscle that comes and goes. This can then lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, pulling the mouth to one side. Eventually the spasms involve all of the muscles on one side of the face almost nonstop. Rarely, doctors see individuals with spasm on both sides of the face.

Most often hemifacial spasm is caused by a blood vessel pressing on the facial nerve at the place where it exits the brainstem. Your doctor will diagnose this condition by performing a physical examination looking for symptoms, and may even use imaging tests, such as an MRI, or a magnetic resonance angiogram (wherein a contrast dye is injected into the blood vessel to make any abnormal vessels apparent).

Injection of botulinum toxin into the affected areas is the most effective therapy. It is also the only one used in most cases. Microvascular decompression surgery relieves pressure on the facial nerve and can provide relief in many cases. This surgery can have significant side effects, so risks and benefits have to be weighed. Drug therapy generally does not work.

The outlook for people with hemifacial spasm depends on the treatment and how they respond. Some people will be nearly free of symptoms with injection therapy. Some may require surgery. In most cases, people are able to find balance between symptoms they can tolerate and risks of treatment.