Hemifacial Spasm Treatment & Diagnosis

A hemifacial spasm is a unilateral involuntary painless contraction of one muscle. It can also affect several groups of facial muscles. Most often, the disorder begins with a twitching of the circular muscle of the eye and passes to half of the face. The diagnosis of hemifacial spasm is simple. The entire half of the face has irregular, uncontrolled contractions. They are usually caused by speech, laughter, or emotional distress. The appearance is so typical that no other methods are necessary to make the diagnosis. But, physicians often prescribe radiological examinations to diagnose. It helps to determine the underlying cause of the compression and treatment. Neurologists use instrumental examinations for hemifacial spasms. First, doctors use MRI in a special mode to treat a hemifacial spasm. This is necessary to rule out vascular and neural conflict in the brain’s structures.

When vascular conflict is detected, doctors use surgical treatment. Medication and botulinum therapy may be helpful. In most cases, doctors use it when they have not confirmed the cause of nerve-vessel contact.

In this article, we will discuss the hemifacial spasm diagnosis and treatment. So read below for more information.

What triggers hemifacial spasm?

There are several causes of hemifacial spasms. One of them can be Parkinson’s disease or dystonia. Hemispasm is usually caused by vascular compression of the facial nerve root. Most often, it is the anterior inferior cerebellar artery. But compression of the posterior inferior cerebellar artery can affect:

• the root by the posterior inferior cerebellar artery;
• the superior cerebellar artery;
• vertebral artery;
• the labyrinthine artery;
• main artery;
• branches of the anterior inferior cerebellar artery. 

Less frequently, compression by vascular malformations or veins is possible. Doctors can recognize these symptoms of hemifacial spasm with MRI.

The cause of hemifacial spasm can sometimes also be:

• benign tumors or cysts in the cerebellopontine angle;
• foci of demyelination in multiple sclerosis;
• adhesions;
• bone deformities;
• tumors of the 4th ventricle, brainstem, and cerebellum. 

Neurological diseases cause hemifacial spasms. These may also include hereditary and genetic diseases. 

Hemifacial Spasm Diagnostic

Usually, the universal hemifacial spasm diagnosis sequence is:

• Neurological examination and interview of the patient;
• MR angiography;
• CT (computed tomography);
• ENMG (electroneuromyography).

Early cases of hemifacial spasm are sometimes difficult to distinguish from:

• facial myokymia;
• tics or myoclonus. 

After all, they can cause pathological processes in the cerebral cortex or the brain stem. In such cases, the most valuable diagnostic method is neurophysiological testing.

There are several criteria for hemifacial spasm diagnosis with corresponding clinical manifestations:

• broad and variable synkinesis in the blink test;
• high-frequency discharges on electromyography (EMG).

Stimulation of one branch of the facial nerve can extend to the entire face. It can also cause a response in a muscle innervated by another branch. Synkinesia is absent in essentially blepharospasm, dystonia, or epilepsy. Needle myography shows irregular, short, high-frequency bursts of potentials of motor units. They correlate with the observed facial movements.

Magnetic resonance imaging is the diagnostic method of choice. MRI  is appropriate when physicians need to rule out compression in a hemifacial spasm. Cerebral angiography is usually ineffective in diagnosing hemifacial spasms. Ectasized blood vessels are rarely detected. And these vascular findings can be difficult to correlate with nerve exposure. Neurologists perform angiography and magnetic resonance. But angiography is usually used for surgical, vascular decompression.

Hemifacial Spasm Treatment Methods

This condition can be frustrating and embarrassing for those who experience it. As it can cause difficulty with facial expressions, eye problems, and social discomfort. Fortunately, several treatment options are available for hemifacial spasms. So can help manage symptoms and improve quality of life.

The most common medical treatments for hemifacial spasms include:

• botulinum toxin injections;
• medical treatment;
• surgical interventions, such as microvascular decompression or facial nerve resection. 

These hemifacial spasm treatments aim to relieve pressure on the affected facial nerve. In doing so, they reduce muscle contractions and improve facial muscle function. Although medical treatments are effective, they may not be suitable for everyone. And some people may prefer alternative or complementary therapies to relieve their symptoms.

Besides medical treatment, alternative therapies may also be great for treating hemifacial spasms. These may include methods such as: 

• acupuncture;
• chiropractic care;
• massage therapy;
• mind-body techniques.

The effectiveness of these treatments may vary from person to person. So, discussing alternative therapies with a doctor before trying them is important. Read more about the most effective hemifacial spasm treatment options.

Botulinum toxin injections

Botulinum toxin injection under electromyography (EMG) monitoring is the best method. Usually, it is a choice for most patients with hemifacial spasms. Chemodenervation is safe and has a good therapeutic effect on most patients. It is especially good for those with persistent contractions. Spasms disappear 3-5 days after injection and last about six months.

Medication hemifacial spasm treatment

Treatment of hemifacial spasms most often begins with medication therapy. Usually, doctors use drugs from different pharmacological groups: 

• baclofen;
• carbamazepine;
• gabapentin;
• clonazepam. 

But, it is necessary to consider their side effects, which can affect patients’ lives. Because hemifacial spasm requires regular intake of the above drugs. Scientists have studied the effects of drugs on these pharmacological groups. They conducted studies on small groups of patients without placebo control. Doctors use botulinum toxin type A quite extensively to treat HPS. Therapists inject it subcutaneously or intramuscularly into the affected muscles. These can include:

• facial muscle palsy;
• ptosis;
• keratitis;
• drooling;
• strabismus.

Hemifacial spasm surgery methods

The best treatment for hemifacial spasms is vascular decompression. Doctors perform this operation only for a reasons. It is needed when the patient is socially disadvantaged and informed about the possible results of treatment. It may not occur immediately but takes about 6-8 months. So it is not customary to revise immediately after surgery. Complete regression after surgery – about 86%. In general, hemifacial spasm surgery is beneficial for treating the disease.

Alternative therapies

There is no conclusive evidence to support alternative therapies for hemifacial spasm treatment. Some people have found them helpful in managing their symptoms: 

• Acupuncture involves the insertion of thin needles into specific points on the body to stimulate energy flow. Some studies have suggested that acupuncture may help reduce muscle spasms. So it improves facial muscle function in people with hemifacial spasms.
• Chiropractors use spinal adjustments and manual techniques to align the body. 
• Mind-body techniques like meditation, yoga, and tai chi can help reduce stress and promote relaxation.

How can you stop facial spasms? 

Besides medical and surgical interventions, certain lifestyle changes can also be beneficial. So people can use them instead of more serious methods, such as hemifacial spasm surgery. These may include stress-reducing techniques such as:

1. meditation or yoga;
2. getting enough sleep;
3. avoiding caffeine and alcohol;
4. maintaining a healthy diet;
5. exercise routine. 

It is important to note that while triggers may exacerbate hemifacial spasm symptoms, they are not the underlying cause. Thus, while managing triggers can help manage symptoms, working with a medical professional is important. They can determine the appropriate treatment plan based on found causes.

If you or a loved one is experiencing symptoms, contact our clinic. Lone Star Neurology has a wide range of services to treat these conditions. Our professional team of neurologists and doctors of the highest calibre will ensure a comfortable treatment and hemifacial spasm diagnosis. Contact our clinic without hesitation, and we will help you!

FAQ 

• What is the first line treatment for hemifacial spasm?

The first-line treatment for hemifacial spasms is botulinum toxin injections. Botulinum toxin is a neurotoxin that temporarily paralyzes the muscles responsible for the spasms, relieving the symptoms. The injections are typically administered every 3-6 months. It depends on the individual’s response and the severity of the condition.

• How long does it take to treat hemifacial spasms?

Typically, botulinum toxin injections, the first-line treatment, relieve symptoms for about 3-6 months and must be repeated regularly for ongoing management. The duration of treatment will be determined on a case-by-case basis by a healthcare professional.

• Can facial massage help in hemifacial spasms?

Yes, some people have reported relief from their symptoms after receiving regular massages. But massage therapy has not been extensively studied for hemifacial spasms.

• How do I stop facial spasms?

Still, the most effective method to relieve facial muscle hypertonicity today is botulinum therapy, which can only be performed by a competent beautician after consultation.