Hemifacial spasm

•Hemifacial spasm is characterised by an involuntary jerks of the facial muscles on one side of the face; it’s responsible of a closure of the eye on one side, and of  twitches of the cheek and around the mouth, giving the appearance of winking .
•It is socially embarrassing and disabling for reading, sewing or anything task which requires visual attention.
•Usually it starts around the eye and spread down to the lower part of the face, and is more frequent on the left side. Less frequently it can start around the mouth and be more prominent around the mouth, distorting the smile and pulling across the philtrum (the median cleft between the nose and  the upper lip).
• Hemifacial spasm is due in most cases to a compression of the facial nerve by an adjacent artery, just after the facial nerve has came out from the brainstem. A Brain MRI is requested to check for other rare causes of nerve compression.
Treatment of Hemifacial spasm
•The first line treatment is Botox injections into the facial muscles which are twitching. It is a very efficient treatment, which requires to be repeated every 4 months. The Botox injection will control easily the eye closure. The control of the spasm around the mouth can be more difficult if the spasm is severe; the injections have to be strong enough to control the spasm, but without weakening too much the muscles responsible of the smile.
•Surgery of vascular decompression (Janetta procedure), will protect the facial nerve by placing a Teflon sponge between the nerve and the artery; it is a surgery performed under microscope and the risks , in addition to any neurosurgical procedure, are the loss of hearing or a facial nerve palsy, on the side of the procedure.
•Dr Marion has been a pioneer in france of treating Hemifacial spasm with Botulinum toxin and has 25 years experience in this treatment. She has participated to the publication on a book on Hemifacial spasm in 1997, presenting at that time her long term results (5 years follow up) of Botox treatment of hemifacial spasm.
•Hemifacial Spasm, a multidisciplinary approach. Eds M. Sindou, Y. Keravel, A.R. Moller. Springer WienNewYork (1997).  Hemifacial spasm: treatment with Botulinum toxin (long term results). Marion MH, p 141-144
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