Hemifacial Spasm Treatment & Management

  • Author: Steven Gulevich, MD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Jun 11, 2010
 

Medical Care

  • Use medications in patients with noncompressive lesions and early idiopathic hemifacial spasm.
  • Response to medication varies but can be satisfactory in early or mild cases.
  • The most helpful agents are carbamazepine and benzodiazepines (eg, clonazepam).
  • Often, medication effects attenuate over time, necessitating more aggressive treatment.
  • Medications may be used in early hemifacial spasm (when spasms are mild and infrequent) or in patients who decline botulinum toxin injection.
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Surgical Care

  • Treat compressive lesions surgically.
    • Ectatic blood vessels cause hemifacial spasm by compressing the facial nerve as it exits the brainstem.
    • Surgical decompression of these blood vessels can yield excellent results.
  • Patients with apparently idiopathic hemifacial spasm may benefit from posterior fossa exploration and microvascular decompression.
  • Myectomy rarely is required.
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Contributor Information and Disclosures
Author

Steven Gulevich, MD  Centennial Medical Center, Centennial, Colorado

Steven Gulevich, MD is a member of the following medical societies: American Academy of Neurology and Colorado Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, 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.

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Ortho McNeil Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Speaking, consulting

Chief Editor

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology

Disclosure: Nothing to disclose.

References

  1. 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].

  2. 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].

  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. 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].

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

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

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

  8. 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].

  9. 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].

  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].

 
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