Hemifacial Spasm

Overview

Hemifacial spasm is a neurological disorder causing involuntary, irregular twitching or spasm of the muscles on one side of the face — typically starting around the eye and progressing to involve the cheek, mouth and neck. It is caused by compression of the facial nerve (cranial nerve VII), most commonly by a blood vessel loop.

Symptoms

• Intermittent facial twitching (starts near eye)
• Progressive involvement of cheek, mouth, neck
• Triggered by stress, fatigue, facial movement
• Unilateral (one side only)

Causes

• Vascular compression of facial nerve (anterior inferior cerebellar artery most common)
• Rarely: tumor, multiple sclerosis

Risk factors

• Age >40
• Hypertension
• Family history of hemifacial spasm

Diagnosis

Clinical diagnosis|MRI to exclude structural causes (tumor, MS)

Treatment & management

Botulinum toxin injections (first-line — highly effective)

Management is individualized and discussed with benefits, limitations, and follow-up.

Prevention & self-care

Microvascular decompression surgery (definitive cure for appropriate candidates)

When to seek medical attention

• Oral medications (baclofen, anticonvulsants — limited benefit)

Frequently asked questions