Hemifacial Spasm

Hemifacial spasm is a condition where half of the muscles in the face go into episodic spasms. It often starts in the eye but then progresses to involve the mouth and sometimes even the neck muscles and at the end stages all these muscles on one side of the face undergo rhythmic contractions and can become quite disabling to patients.

It’s not particularly a painful condition but it is very stressful to patients. It often affects adults in middle age and into the advanced years and often affects females a little bit more frequently than males.
The cause of hemifacial spasm is a blood vessel in the back of the brain that pulsates with every heartbeat against the nerve and causes the nerve to be hyper-irritable. So any contraction of the face is magnified and involves all the muscles in the face. So what’s thought is that as we age our vessels become elongated and start to form loops and this loop just happens to be located against the facial nerve and causes it to become irritable.

Oral medications have been tried and are usually not effective for hemifacial spasm. The other non-surgical treatment is where botulinum toxin is injected in low doses which interrupts the connections between the nerves and the muscles, is injected in the affected area and that often calms down the spasms for a period of time. It does require the patient get re-injected because the botulinum toxin tends to wear off over time.

The other more definitive treatment is called a microvascular decompression where we make an incision behind the ear and go in with a high powered microscope along the cerebellum, the back of the brain, and find the vessel that is pulsating against the facial nerve and move that aside and then pad it with a teflon sponge or teflon padding. That usually removes any pulsations against the nerve and often is a curative for provides long term relief from the hemifacial spasms. It’s been studied in thousands of patients over a large series of patients have been recorded in the medical literature and it’s usually about ninety percent effective in eliminating the symptoms.

Like any surgery there are risks and patients have to be in good medical condition. Small risks of infections, fluid leak, there’s small risk of hearing loss because the facial nerve and the hearing or the auditory nerve run right together. There’s a very small risk of some facial weakness and some other nerve to the face can be affected, but we do monitoring to try and minimize these and most of the time patients do very well.

After having the surgery the patients are often extremely grateful because it’s such a dramatic effect of having that condition and then all of a sudden they wake up in the recovery room and they have the typical patient has no more spasms after the operation.

At the Neuroscience Institute at Swedish we specialize in somewhat rare conditions like hemifacial spasms and other conditions that have neurosurgical treatments and we do high volumes of these surgeries and we get excellent results because the teams are well trained and the nurses are well trained and the anesthesiologists and monitoring people are very used to taking care of these conditions. We have a routine and protocol for these patients and they tend to do extremely well.