Hemifacial Spasm (Face Twitching)

Overview

What is hemifacial spasm?

Hemifacial spasm is a neurological disorder. It causes involuntary muscle twitches (spasms) on one side (hemi-) of the face (facial).

Who might get hemifacial spasm?

Both men and women can get hemifacial spasm. Women over 40 are more likely to have the condition.

Symptoms and Causes

What causes hemifacial spasm?

Hemifacial spasm occurs because of compressed facial nerves. Nerves are the organs that send electrical impulses from one part of the body to another. This network of electrical signals makes up your nervous system.

Most often, twitches occur because a blood vessel (tube that carries blood around the body) presses a facial nerve. Benign (not cancer) head and neck tumors may also press on nerves.

Sometimes, the facial twitches have no obvious cause. When there is no known cause, healthcare providers call the condition idiopathic hemifacial spasm.

What are the symptoms of hemifacial spasm?

Usually, the first symptom of hemifacial spasm is intermittent eye twitching. Eye twitching does not usually indicate a health problem. If you have hemifacial spasm, eye twitching progresses to twitching in other parts of the face.

With hemifacial spasm, twitches can pull the mouth to one side. Over time, twitches occur continuously. The spasms may worsen when you’re stressed or tired.

Diagnosis and Tests

How is hemifacial spasm diagnosed?

Your healthcare provider will conduct a neurological exam to diagnose hemifacial spasm. Neurological exams help evaluate your brain function. You’ll likely have a magnetic resonance imaging (MRI). An MRI uses radio waves and magnets to create images of the inside of your body.

Management and Treatment

How is hemifacial spasm treated?

Depending on symptom severity, your healthcare provider may recommend:

  • Oral medication.
  • Botulinum toxin type A (Botox®) injections.
  • Surgery.

What are the oral medications for hemifacial spasm?

Oral medication may be the first line of treatment if your symptoms are mild. These medications interrupt the brain’s electrical signals that cause spasms. Common oral medications include:

  • Carbamazepine (Tegretol®).
  • Clonazepam (Klonopin®).
  • Baclofen (Lioresal®).

What are the side effects of oral medications for hemifacial spasm?

Hemifacial spasm drugs may cause mild to moderate side effects, such as:

What are botulinum toxin injections?

For most people, botulinum toxin injections are the most effective treatment for hemifacial spasm.

A healthcare provider uses a tiny needle to inject a small amount of botulinum toxin around affected facial muscles. These injections temporarily weaken the muscles and stop the spasms. Most people need injections every three to six months.

What are the side effects of injections for hemifacial spasm?

In the first three days after a botulinum toxin (such as Botox®) injection, you may experience:

  • Eye irritation.
  • Eyelid drooping.
  • Temporary facial weakness.

What happens during surgery for hemifacial spasm?

A blood vessel pressing on the facial nerve may cause spasms. In this case, healthcare providers may recommend microvascular decompression (MVD) surgery.

In MVD surgery, a surgeon uses a tiny metal plate to relieve the compression. It stops the facial spasms. During the procedure, the surgeon:

  • Lifts away a small part of the skull.
  • Identifies the blood vessel pressing on your facial nerve.
  • Places a metal plate between the nerve and blood vessel.
  • Closes the skull with another small metal plate and screws.

What are the side effects of surgery for hemifacial spasm?

People who get MVD surgery for hemifacial spasm may experience:

  • Decreased hearing.
  • Facial weakness.

Is there a cure for hemifacial spasm?

There is no guaranteed cure for hemifacial spasm. For most people, symptoms get better or go away with treatment.

Prevention

How can I prevent hemifacial spasm?

There is no proven way to prevent hemifacial spasm.

Some conditions have symptoms that are like those of hemifacial spasm. Conditions that affect the facial nerves include:

Outlook / Prognosis

Is hemifacial spasm a temporary or chronic condition?

Hemifacial spasm is usually a chronic (long-lasting) condition.

Does hemifacial spasm return after treatment?

If you choose oral medication or injection therapy, you will need to continue treatment long-term. If you stop treatment, your spasms may return.

Surgery usually resolves hemifacial spasm symptoms. But, even with surgery, there is a chance that the twitches will come back.

Living With

How can I best learn to cope with hemifacial spasm?

If you have hemifacial spasm, you can minimize your symptoms by:

A note from Cleveland Clinic

Hemifacial spasm is a chronic neuromuscular condition. Hemifacial spasm causes twitching that you can’t control on one side of the face. Usually, symptoms start around the eye and move downward. There is no cure, but medicine, botulinum toxin injections or surgery can help control your symptoms. You and your provider can work together to decide your best course of treatment.

Last reviewed by a Cleveland Clinic medical professional on 04/09/2021.

References

  • Cochrane Library. Botulinum toxin type A therapy for hemifacial spasm. (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004899.pub3/full) Accessed 4/13/2021.
  • Merck Manual. Hemifacial Spasm. (https://www.merckmanuals.com/en-pr/professional/neurologic-disorders/neuro-ophthalmologic-and-cranial-nerve-disorders/hemifacial-spasm) Accessed 4/13/2021.
  • National Institute of Neurological Disorders and Stroke. Hemifacial Spasm Information Page. (https://www.ninds.nih.gov/disorders/all-disorders/hemifacial-spasm-information-page) Accessed 4/13/2021.

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