Hemifacial Spasm Workup

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

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.
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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.
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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.

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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.
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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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