HEMIFACIAL SPASMS

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Hemifacial spasms are involuntary muscle contractions on one side of the face, caused by irritation or compression of the facial nerve (cranial nerve VII). These spasms can start around the eye and gradually spread to other parts of the face.

Hemifacial spasms are relatively rare, affecting about 8 out of 100,000 people annually. They are more common in middle-aged and older adults and tend to occur slightly more frequently in women than in men.

The primary symptom of hemifacial spasms is the involuntary twitching or contraction of muscles on one side of the face. Other symptoms include:

• Brief, intermittent twitching around the eye
• Spasms that spread to the lower face, mouth, and neck over time
• Continuous or persistent spasms in severe cases
• Spasms that may worsen with stress, fatigue, or movement
• Difficulty closing the eye on the affected side
• Asymmetry of facial expressions due to muscle contractions

Diagnosing hemifacial spasms involves several steps:

• Medical History and Physical Exam: Your doctor will review your symptoms and perform a neurological examination, focusing on the facial nerve.
• Imaging Tests: MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans are often used to identify any blood vessels, tumors, or other structures pressing on the facial nerve.
• Electromyography (EMG): This test measures the electrical activity of muscles and can help confirm the diagnosis by identifying abnormal muscle contractions.

Treatment for hemifacial spasms aims to relieve symptoms and improve quality of life. Options include:

• Medications: Drugs may be prescribed to reduce muscle spasms and nerve irritability. Common medications include:
  • Anticonvulsants: Such as carbamazepine and gabapentin, which help to reduce nerve-related pain and spasms.
  • Muscle Relaxants: Such as baclofen, which can help alleviate muscle contractions.
  • Botulinum Toxin (Botox) Injections: Botox injections are commonly used to temporarily paralyze the affected muscles, providing relief from spasms for several months. This treatment needs to be repeated periodically.
• Surgery: Surgical options may be considered if medications and Botox injections are not effective:
  • Microvascular Decompression (MVD): The most common surgical procedure for hemifacial spasms. It involves relieving the pressure on the facial nerve by repositioning or removing the blood vessel causing the compression. This procedure often provides long-term relief.

• Microvascular Decompression (MVD): The gold standard surgical treatment. During this procedure, a small incision is made behind the ear, and the surgeon repositions or removes the blood vessel pressing on the facial nerve. This technique aims to provide long-term relief by addressing the underlying cause of the spasms.
• Selective Peripheral Neurectomy: In rare cases where MVD is not suitable, a selective peripheral neurectomy may be performed. This involves cutting specific nerve branches to reduce muscle contractions, but it is less common due to potential side effects and lower success rates.

Early diagnosis and treatment of hemifacial spasms can improve outcomes and quality of life. If you experience symptoms or have concerns about hemifacial spasms, it's important to consult your healthcare provider for a thorough evaluation.