eMedicine Specialties > Neurology > Neuromuscular Diseases

Hemifacial Spasm: Differential Diagnoses & Workup

Author: Steven Gulevich, MD, Department of Neurology, Swedish Medical Center of Englewood, Colorado
Contributor Information and Disclosures

Updated: Feb 3, 2009

Differential Diagnoses

Other Problems to Be Considered

Benign essential
Blepharospasm
Oromandibular dystonia
Craniofacial tremor
Facial chorea
Tics
Facial myokymia

Workup

Laboratory Studies

  • Early cases of hemifacial spasm may be difficult to distinguish from facial myokymia, tics, or myoclonus originating in the cortex or brainstem.
    • Neurophysiologic testing can be invaluable.
    • Spread and variable synkinesis on blink reflex testing and high-frequency discharges on EMG (with appropriate clinical findings) are diagnostic.
    • Stimulation of one branch of the facial nerve may spread and elicit a response in a muscle supplied by a different branch.
    • Blink reflex studies may reveal synkinesis, which is not present in essential blepharospasm, dystonia, or seizures.
    • Needle EMG shows irregular, brief, high-frequency bursts (150-400 Hz) of motor unit potentials, which correlate with clinically observed facial movements.

Imaging Studies

  • Magnetic resonance imaging is the imaging study of choice, especially if an underlying compressive lesion is suspected.
  • Perform angiography and/or magnetic resonance angiography prior to a vascular decompression surgical procedure.

Other Tests

Cerebral angiography offers little diagnostic value in hemifacial spasm. Ectatic blood vessels rarely are identified, and it is difficult to correlate vessels with the facial nerve. As angiography may identify an aneurysm or vascular anomaly, it often is performed prior to decompressive surgery to clarify the vascular anatomy.

Procedures

  • In most patients, the treatment of choice is injection of botulinum toxin under EMG guidance.
    • Chemodenervation safely and effectively treats most patients, especially those with sustained contractions.
    • Relief of spasms occurs 3-5 days after injection and lasts approximately 6 months.
  • Side effects of botulinum toxin injection (eg, facial asymmetry, ptosis, facial weakness) usually are transient.
    • Most patients report a highly satisfactory response.
    • Caution patients that although botulinum toxin ablates the muscular spasm, the sensation of spasm often persists.

More on Hemifacial Spasm

Overview: Hemifacial Spasm
Differential Diagnoses & Workup: Hemifacial Spasm
Treatment & Medication: Hemifacial Spasm
Follow-up: Hemifacial Spasm
References
[ CLOSE WINDOW ]

References

  1. Adler CH, Zimmerman RA, Savino PJ, et al. Hemifacial spasm: evaluation by magnetic resonance imaging and magnetic resonance tomographic angiography. Ann Neurol. Oct 1992;32(4):502-6. [Medline].

  2. Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm. J Neurosurg. Sep 2008;109(3):416-20. [Medline].

  3. Colosimo C, Chianese M, Giovannelli M, et al. Botulinum toxin type B in blepharospasm and hemifacial spasm. J Neurol Neurosurg Psychiatry. May 2003;74(5):687. [Medline].

  4. Cruccu G, Inghilleri M, Berardelli A, et al. Pathophysiology of hemimasticatory spasm. J Neurol Neurosurg Psychiatry. Jan 1994;57(1):43-50. [Medline].

  5. Elston JS. The management of blepharospasm and hemifacial spasm. J Neurol. Jan 1992;239(1):5-8. [Medline].

  6. Jankovic J, Schwartz K, Donovan DT. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm. J Neurol Neurosurg Psychiatry. Aug 1990;53(8):633-9. [Medline].

  7. Jannetta PJ, Abbasy M, Maroon JC, et al. Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg. Sep 1977;47(3):321-8. [Medline].

  8. Kraft SP, Lang AE. Cranial dystonia, blepharospasm and hemifacial spasm: clinical features and treatment, including the use of botulinum toxin. CMAJ. Nov 1 1988;139(9):837-44. [Medline].

  9. Mauriello JA, Leone T, Dhillon S, et al. Treatment choices of 119 patients with hemifacial spasm over 11 years. Clin Neurol Neurosurg. Aug 1996;98(3):213-6. [Medline].

  10. Moller AR. The cranial nerve vascular compression syndrome: I. A review of treatment. Acta Neurochir (Wien). 1991;113(1-2):18-23. [Medline].

  11. Moller AR. The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta Neurochir (Wien). 1991;113(1-2):24-30. [Medline].

  12. Reimer J, Gilg K, Karow A, et al. Health-related quality of life in blepharospasm or hemifacial spasm. Acta Neurol Scand. Jan 2005;111(1):64-70. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hemifacial spasm, craniofacial movement disorders, facial myoclonus, facial dystonia, botulinum toxin, BTX therapy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Steven Gulevich, MD, Department of Neurology, Swedish Medical Center of Englewood, Colorado
Steven Gulevich, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.