Hemifacial spasm (HFS) is a neurological condition characterized by repetitive, involuntary twitching of the muscles on one side of the face. Over time, the twitching may progress and affect more muscles. The term “hemifacial” means “half of the face,” while “spasm” refers to muscle twitching.
This condition typically begins in adulthood, most commonly between the ages of 40 and 60. Doctors classify HFS as a peripheral movement disorder, which means it affects the peripheral nervous system—the system responsible for transmitting sensory information to the brain. Disturbances in this system can trigger facial twitching that impacts a patient’s quality of life.
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Types of Hemifacial Spasm
Hemifacial spasm is divided into two types, depending on how symptoms develop:
- Primary hemifacial spasm: Twitching usually takes months or years before it spreads to the lower facial muscles.
- Secondary hemifacial spasm: Twitching affects both the upper and lower face simultaneously. Symptoms may start intermittently but eventually become more frequent.
Causes of Hemifacial Spasm
The primary cause of hemifacial spasm is chronic irritation of the facial nerve (cranial nerve VII). Several factors and conditions can trigger this irritation.
Humans have two facial nerves, one for each side of the face. These nerves originate from the brainstem and extend to various areas of the face, including the temples, cheeks, nose, mouth, chin, and upper neck. The facial nerves play important roles in:
- Controlling facial muscle movements for expressions.
- Parasympathetic functions in the salivary glands and tear glands.
- Sensory functions in the front two-thirds of the tongue.
Causes of Primary HFS
Primary HFS occurs when an abnormally positioned blood vessel compresses the facial nerve root. This pressure damages the protective myelin sheath, disrupting nerve signal transmission and causing uncontrolled muscle twitching. This is the most common cause of hemifacial spasm.
Causes of Secondary HFS
Secondary HFS is caused by underlying medical conditions that irritate the facial nerve, such as:
- Facial nerve trauma or injury.
- Bell’s palsy.
- Brainstem lesions from multiple sclerosis or stroke.
- Vascular problems, such as brain aneurysms, arteriovenous fistulas, or angiomas.
- Ear disorders like middle ear infections (otitis media), mastoiditis, or cholesteatoma.
- Parotid gland tumors.
- Chiari malformation or structural abnormalities in the posterior cranial fossa.
Symptoms of Hemifacial Spasm
The hallmark symptom of hemifacial spasm is involuntary twitching on one side of the face. HFS affects the left side more frequently than the right. In rare cases, twitching may appear on both sides.
Early symptoms usually begin as intermittent eyelid twitching. Over time, they may progress to:
- Uncontrolled eye closure.
- Eyebrow twitching or lifting.
- Twitching of the lower face that pulls the mouth to one side.
- Twitching involving all muscles on one side of the face, which may occur almost constantly.
Although hemifacial spasm is typically painless, it can cause embarrassment and emotional distress. Symptoms often worsen with stress, fatigue, eating, or anxiety. Twitching can also persist during sleep, leading to sleep disturbances or insomnia.
Additional Symptoms
Some patients may also experience:
- Clicking sounds in the ear.
- Ear pain.
- Hearing problems (more common in secondary HFS).
How is Hemifacial Spasm Diagnosed?
To diagnose hemifacial spasm, doctors perform physical and neurological examinations to assess facial nerve function.
In many cases, a brain MRI is recommended to identify the underlying cause and rule out other conditions. In primary HFS, MRI often reveals abnormal blood vessels pressing on the facial nerve.
Since HFS symptoms may resemble other involuntary movement disorders such as blepharospasm or partial motor seizures, additional tests like electromyography (EMG) may be used to confirm the diagnosis.
Treatment for Hemifacial Spasm
The main goal of hemifacial spasm treatment is to reduce the frequency and severity of muscle spasms. Treatment options depend on the underlying cause and the patient’s condition.
1. Botox Injections
Botulinum toxin (Botox) injections are the first-line treatment for HFS. They work by temporarily weakening the affected facial muscles.
Improvement is usually noticeable within 3–6 days, and effects last for 3–4 months, requiring repeat injections. Possible side effects include:
- Eye irritation.
- Drooping eyelids.
- Temporary facial muscle weakness.
2. Medications
For patients who cannot or prefer not to undergo injections or surgery, oral medications may be prescribed, such as:
- Anticonvulsants (carbamazepine, gabapentin).
- Benzodiazepines (clonazepam).
- Muscle relaxants (baclofen).
- Tricyclic antidepressants.
- Antipsychotics (haloperidol).
These medications may help, but they are not always effective and can cause side effects such as fatigue and sedation with long-term use.
3. Surgery
Surgery is the only permanent solution for hemifacial spasm, typically reserved for severe cases or when Botox no longer works.
The most common procedure is microvascular decompression (MVD), which relieves pressure on the facial nerve caused by abnormal blood vessels. If successful, patients can achieve long-term relief.
However, as with any surgery, MVD carries risks, including:
- Anesthesia complications.
- Temporary or permanent facial paralysis.
- Hearing loss.
- Cerebrospinal fluid (CSF) leakage.
Microvascular Decompression (MVD) for Hemifacial Spasm at Mandaya Royal Hospital Puri
Mandaya Royal Hospital Puri offers treatment for hemifacial spasm through microvascular decompression (MVD), performed by one of Indonesia’s leading neurosurgeons, Dr. dr. Mardjono Tjahjadi, Sp.BS, Subsp. N-Vas, F. N-Onk, PhD, FICS, IFAANS, also known as Dr. Joy.
MVD is a neurosurgical procedure designed to reduce vascular compression of cranial nerves, particularly the facial nerve. In HFS, an abnormally positioned blood vessel presses on the facial nerve, disrupting its function and causing repetitive twitching.
During surgery, the surgeon separates the blood vessel from the nerve using a special cushion (often a small piece of Teflon) to prevent further compression.
📌 See also: Patient with Facial Twitch Undergoes MVD Surgery at Mandaya Royal Hospital Puri
Dr. Joy’s Practice Schedule at Mandaya Royal Hospital Puri
- Monday: by appointment
- Tuesday: 14:00 – 17:00 WIB
- Wednesday: by appointment
- Thursday: 08:00 – 12:00 WIB
- Friday: 14:00 – 17:00 WIB
- Saturday: 08:00 – 12:00 WIB
If you would like to consult Dr. Joy regarding MVD surgery and hemifacial spasm, visit Mandaya Royal Hospital Puri.
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