Hemifacial Spasm
Hemifacial spasm is a condition with involuntary twitching or contractions of the muscles on one side of the face.
What is Hemifacial Spasm?
Hemifacial spasm is a condition with involuntary twitching or contractions of the muscles on one side of the face. It is caused by abnormal firing of the facial nerve, typically due to compression of the nerve by a blood vessel.
Hemifacial spasm begins as intermittent, painless twitching around one eye. It is often mistaken initially for a benign eye tic or fatigue, before gradually spreading to involve the cheek and mouth. Unlike similar nerve compression conditions, hemifacial spasm is not painful. However, it can be highly distressing, socially embarrassing, and in severe cases can be frequent enough to affect vision or make it hard to control facial movement.
At One Brain and Spine, our neurosurgeons have extensive experience in the surgical treatment of hemifacial spasm.
What Causes Hemifacial Spasm?
Vascular Compression
The most common cause of hemifacial spasm is a blood vessel pressing on the facial nerve at the point where it leaves the brainstem. This pressure disrupts the normal electrical signals in the nerve, causing it to misfire and trigger involuntary muscle movements in the face.
Secondary Causes
Less often, hemifacial spasm is caused by a mass near this part of the brain, such as an acoustic neuroma, meningioma, or epidermoid cyst. MRI is performed to exclude these secondary causes.
Symptoms of Hemifacial Spasm
Hemifacial spasm usually starts with mild, painless twitching around one eye, often triggered by tiredness or stress. Over time, it gradually spreads to the cheek, mouth, and sometimes the neck, on the same side of the face.
As it progresses, spasms can become strong enough to briefly close the eye, affecting vision and making things like driving harder. In more advanced cases, the muscles may stay tightly contracted for long periods rather than just twitching. Some people also notice a clicking sound in the ear on the affected side during spasms. Spasms are often exacerbated by fatigue, stress, or bright light.
Unlike some other nerve compression conditions, hemifacial spasm is not painful.
How is Hemifacial Spasm Diagnosed?
Hemifacial spasm is diagnosed based on its characteristic appearance of unilateral facial twitching beginning around the eye. Investigations are performed to confirm the diagnosis and check for secondary causes. These include:
- MRI brain with dedicated neurovascular sequences – identifies vessel contact at the facial nerve root entry zone and excludes secondary structural causes such as a tumour or cyst.
- A nerve test (EMG) — this measures the electrical activity in the facial muscles and can help confirm the diagnosis in some cases.
Treatment of Hemifacial Spasm
Botulinum Toxin (Botox) Injections
Small injections into the affected muscles help relax them and reduce spasms, usually for around 3–4 months at a time before treatment needs repeating. Botox doesn't fix the underlying cause, but it's a safe, low-risk option. Temporary side effects can include local bruising, a drooping eyelid, or facial weakness.
Microvascular Decompression (MVD) — Definitive Surgical Treatment
MVD is the only treatment that fixes the underlying cause of hemifacial spasm. It offers the best chance of a lasting cure.
During the operation, a small opening is made in the skull behind the ear. Using a microscope, the surgeon gently moves the blood vessel that is pressing on the nerve and places a small soft pad between them to stop the pressure. MVD achieves complete resolution of symptoms in approximately 85–90% of patients with a low chance of long-term recurrence.
At One Brain and Spine, our neurosurgeons perform MVD using the latest microsurgical technique and intraoperative neuromonitoring.
Observation
Mild, infrequent hemifacial spasm causing minimal functional impairment may be monitored without treatment. Unfortunately, the condition rarely resolves spontaneously and tends to progress over time.
Frequently Asked Questions — Hemifacial Spasm Melbourne
Is hemifacial spasm dangerous?
Hemifacial spasm is not life-threatening. However, it can be highly disabling, interfering with vision, social interaction, driving, and work. Without treatment, it tends to slowly get worse over time. The good news is that both Botox and MVD surgery offer effective treatment options.
What is the difference between hemifacial spasm and a facial tic?
Facial tics are usually brief and repetitive, and most people can consciously stop them for a short time. Hemifacial spasm is completely involuntary and can't be controlled or suppressed. It only affects one side of the face, usually starts around the eye, and tends to get worse over time.
How long does Botox last for hemifacial spasm?
Botox injections typically last around 3–4 months before the spasms start to return. Most people need treatment three to four times a year to keep symptoms under control. MVD surgery offers a more long-term solution for appropriate patients.
Is MVD safe for hemifacial spasm?
MVD is generally considered a safe procedure, especially when performed by experienced surgeons. During surgery, the nerves involved in facial movement and hearing are carefully monitored to reduce risk. Possible risks include temporary or, rarely, permanent facial weakness and hearing loss along with the general risks of brain surgery. For the right patients, surgery offers a strong chance of a lasting cure with a low risk of complications.
Why Choose One Brain and Spine for Hemifacial Spasm in Melbourne?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, bringing together extensive expertise in brain, spinal, and peripheral nerve surgery. Our team has particular strength in the management of hemifacial spasm, delivering multidisciplinary care using the latest technology available in Australia. We are committed to providing comprehensive, patient-focused treatment through:
- Specialist neurosurgeons — fellowship-trained with subspecialty cranial expertise
- Advanced surgical technology and microsurgery
- Multidisciplinary care across Melbourne
- Patient-centred, compassionate approach
- All major health funds accepted