Hemifacial Spasm

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Treatment

There are three treatments for hemifacial spasm: medication, surgery, and botulinum toxin injections. In most cases, the treatment of choice is botulinum toxin injections, also known as BOTOX® Cosmetic or BTX.

Botulinum Toxin
BTX is produced by the Clostridium botulinum bacterium. It is the same toxin that produces botulism (i.e., food poisoning). When injected into the eyelid in minute amounts, BTX is effective in stopping spasms for several months. Because the effects are temporary, the treatment must be repeated periodically. Side effects include drooping eyelids, double vision, and dry eyes. These side effects lessen in time. More about botulinum toxin injections.

Medication
Medication is used in mild cases and in patients who refuse BTX or surgery. Benzodiazepines (anxyolytic used as muscle relaxant) and carbamazepine (Tegretol®; antiseizure drug) can help control muscle spasms but are usually less successful than BTX.

These medications produce side effects in the central nervous system, including:

• Apathy
• Clouding of mental faculties
• Dizziness
• Fatigue
• Headaches
• Impaired motor coordination
• Nausea and vomiting

Long-term use of benzodiazepines can lead to dependence. When used with other depressants (e.g., alcohol), there is a great risk for severe respiratory and cardiovascular depression. Drug interactions also can be severe, so the physician should be informed of all prescription and over-the-counter drugs being taken.

Carbamazepine can cause potentially serious adverse effects and the patient is monitored for low white blood cell or platelet counts, signs of bone marrow depression, and liver damage. Patients with high intraocular pressure (IOP) also are monitored because carbamazepine can increase pressure.

Surgery
Surgery is indicated for severe symptoms caused by blood vessel compression that does not respond to other therapies. In th Janetta procedure, also called microvascular decompression, the blood vessel that is pressing on the facial nerve is repositioned to relieve pressure. This treatment is usually successful and most patients do not require further treatment.

Microvascular decompression is performed by a neurosurgeon in a hospital under general anesthesia and carries associated risks. Some patients have a residual spasm, particularly around the eye, that takes days to months to resolve.

Prevention

There is no way to prevent hemifacial spasm.

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