Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hemifacial Spasm Workup

  • Author: Steven Gulevich, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
 
Updated: May 16, 2016
 

Approach Considerations

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 electromyography (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. Synkinesis 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.

Next

Imaging and Other Studies

Magnetic resonance imaging is the imaging study of choice, especially if an underlying compressive lesion is suspected. 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. Perform angiography and/or magnetic resonance angiography prior to a vascular decompression surgical procedure. Angiography is often performed before decompressive surgery to clarify the vascular anatomy, because it may identify an aneurysm or vascular anomaly.[7]

Previous
 
 
Contributor Information and Disclosures
Author

Steven Gulevich, MD Centennial Medical Center, Colorado

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

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References
  1. Abbruzzese G, Berardelli A, Defazio G. Hemifacial spasm. Handb Clin Neurol. 2011. 100:675-80. [Medline].

  2. Yaltho TC, Jankovic J. The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord. 2011 Aug 1. 26(9):1582-92. [Medline].

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

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

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

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

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

  8. Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond DJ, et al. Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm. Neurosurg Focus. 2013 Mar. 34(3):E3. [Medline].

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

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

  11. 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. 1977 Sep. 47(3):321-8. [Medline].

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

  13. Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg. 2011 Dec 15. [Medline].

  14. Thirumala PD, Shah AC, Nikonow TN, Habeych ME, Balzer JR, Crammond DJ, et al. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol. 2011 Feb. 28(1):56-66. [Medline].

  15. Ma Q, Zhang W, Li G, Zhong W, Yang M, Zheng X, et al. Analysis of therapeutic effect of microvascular decompression surgery on idiopathic hemifacial spasm. J Craniofac Surg. 2014 Sep. 25(5):1810-3. [Medline].

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

  17. 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. 1990 Aug. 53(8):633-9. [Medline]. [Full Text].

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

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.