A hemifacial spasm is a medical condition categorized by an involuntary twitching or contraction of the facial muscles on one side of a person’s face. The condition comes in two different forms, known as typical and atypical hemifacial spasms. Today, we take a closer look at the two forms of hemifacial spasms, and we walk you through some of the common treatment techniques.

Typical and Atypical Hemifacial Spasms

Here’s a quick overview of the two types of hemifacial spasms:

Typical Hemifacial Spasm – A typical spasm involves the development of a tic near the patient’s eye, which eventually progresses down the person’s face over time. The twitching is not painful, but it can be embarrassing and interfere with a person’s vision or expression at times. 92 percent of hemifacial spasms are of the typical variety.

Atypical Hemifacial Spasm – During an atypical spasm, the twitching begins in the chin and cheek area and progresses upwards. Again, it is not painful, but it can be annoying. Less than 1 in 10 people who develop a hemfacial spasm will deal with an atypical spasm.

Hemifacial Spasm Onset and Treatment

If a patient has a typical hemifacial spasm, they’ll begin to notice that twitching begins in the lower eyelid in the orbicularis oculi muscle. Eventually, the condition will spread to the entire eyelid, and then to the orbicularis oris muscle around the lip. Then it will make its way to the buccinator muscle in the cheekbone. During an atypical hemifacial spasm, the opposite occurs. The spasm begins in the cheekbone and works its way up to the eyelid.

The condition is caused by an injury to the facial nerve, compression on the nerve, or Bell’s palsy. Oftentimes a hemifacial spasm is caused by compression of your facial nerve by the anterior inferior cerebellar artery where the nerve begins at your brainstem. This compression causes the nerve to send incorrect signals to the brain, which leads to the muscle contractions.

Treatment of the condition first begins with an accurate diagnosis. Your doctor will examine your medical history and conduct a neurological exam. Your doctor may also perform an MRI to ensure a more life-threatening condition like a tumor or aneurysm is not causing the problem. Finally, you may be asked to undergo an electromyogram of the face, which helps to measure the muscle and nerve electrical activity in your face. Once diagnosed with a hemifacial spasm, your doctor will walk you through your treatment options, which include:

Medications – You may be given an anti-convulsion drug to stop the nerve from firing. Other drugs like muscle relaxants are also helpful, but patients will need to be monitored for any adverse health effects like nausea, dependence and blood disorders.

Injections – A Botox injection can sometimes calm the tic by paralyzing the electrical signals that are causing the nerve to fire. Botox injections have high success rates, but only in the short term. Once administered, the nerve is typically blocked for about three months, at which point the patient may need another round of injections. Also, after years repeated injections, the effectiveness begins to wear off.

Surgery – If the first two options fail, surgery may be your best option. In these scenarios, the surgeon will perform a microvascular decompression to relieve pressure on the affected nerve. The neurosurgeon does this by making a tiny hole in the back of your head and inserting a tiny micro Teflon sponge between the offending blood vessel and the facial nerve.