But we sometimes come across a condition that starts quite innocuously, often with an occasional twitching in an eyelid, yet it can still end up requiring surgery to prevent damage to the facial nerve being impacted.
This is known as hemifacial spasm.
What is hemifacial spasm?
Hemifacial spasm is a nervous disorder in which the muscles on one side of the patient’s face twitch involuntarily. The condition often begins with occasional twitching in an eyelid. From there, if allowed to progress, the condition can end with a complete closure of the affected eye.
In hemifacial spasm, the muscle spasms usually spread downward on the face, moving to the lower portion where it may cause contortions such as a sideways pulling of the mouth. Eventually every muscle on the affected side may experience increasingly frequent spasms.
What causes hemifacial spasm?
Hemifacial spasm is most often caused by a blood vessel touching a facial nerve. This occurs when the blood vessel creates excessive pressure on a facial nerve where it exits the brainstem. It can also be a signal that there is a tumor in the area creating the same pressure on the facial nerve.
In some cases, unfortunately, a cause cannot be identified.
How is hemifacial spasm treated?
This condition has much in common with a condition known as blepharospasm, the involuntary twitching solely of an eyelid. In that condition, the usual treatment is injection of Botox. Botox is made of the botulinum toxin type A, and when it is injected into a muscle it temporarily stops that muscle from contracting. When injected into the muscle creating blepharospasm, it blocks the contractions and stops the twitching. This actually was the first approved usage of Botox (which has since become renowned for removing wrinkles on the upper third of the face) by the FDA.
We use Botox in many patients with hemifacial spasm, as well. By blocking the nerve messages sent from the muscle to the brain (the mechanism by which the botulinum toxin keeps the injected muscle at rest), the muscles never are signaled to contract. This stops the spasms triggered by the pressure on the facial nerve. Botox injections are usually quite successful.
In some cases, Botox does not stop the spasms. Our Texas Neurosurgery neurosurgeons may then need to perform a procedure known as microvascular decompression, which alleviates pressure on the facial nerve.
If you’ve noticed twitching in an eyelid or elsewhere on one side of your face, and if these spasms continue, we should see you. Call us at Texas Neurosurgery, (214) 823-2052, and let’s check out what is going on.
