Hemifacial Spasm

Hemifacial spasm is a neuromuscular disorder that is characterised by frequent, involuntary contractions of the muscles on one side of the face. It affects muscles activated by the facial nerve.

A facial nerve injury or a tumour may cause this condition but a definite cause cannot be identified in most cases. In many hemifacial spasm sufferers, their condition may be caused by the pressure of a blood vessel or artery on a facial nerve.

Who are at risk?

This disorder afflicts both men and women, although it has been found to affect more middle-aged and elderly women.

Who are the symptoms?

The first symptom is that of sporadic twitching of the eyelid muscle. This leads to the forced closure of the eye. Gradually, the spasm spreads to involve other muscles of the lower face, which could result in the mouth being pulled to one side. Eventually, the spasms involve all the muscles on one side of the face almost incessantly.

This condition does not cause pain for the hemifacial spasm sufferer but in time, may cause weakness in the facial muscles.

In more severe cases, the spasms may cause the sufferer's mouth to become clamped shut, making speaking, eating and swallowing difficult.

How is it diagnosed?

Diagnosis may include a nerve conduction study and electromyography (EMG) conducted by an experienced neurologist to examine the electrical activities of facial twitching. As the electric stimulus is initiated, the results appear on an oscilloscope or viewer or are photographed.

A brain Magnetic Resonance Imaging or MRI may also be used to detect tumours or masses of growth, which could cause this condition. The MRI is a diagnostic tool that uses a strong magnetic field and radio frequency waves to create images of the body.

How is it treated?

Medications

There has been limited success with oral medication to treat hemifacial spasm. Patients who have benefited through drug therapy were those suffering from milder cases of hemifacial spasm.

Botulinum Toxin or Botox injections are useful in treating hemifacial spasm. The injections are into affected areas, usually the muscles of the eyelid, cheekbone area and those below the cheekbone. The effectiveness of this treatment is temporary and periodic injections are required quarterly to half yearly.

Procedures

Microvascular Decompression (MVD) Surgery is an alternative for those intolerant of drug therapy or Botox. In MVD, a neurosurgeon surgically separates one or more blood vessels or arteries that are impinging on the facial nerve. A small cut is made behind the ear on the affected side and a small opening is made in the bone.

Tiny implants are used to maintain the separation of the blood vessel or artery, preventing it from resting on the nerve. Improvement of hemifacial spasm can be achieved in about 80 per cent of patients. n

Source : Singapore Medicine

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