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Hemifacial Spasm.

Lawrence W. Kemp1, Stephen G. Reich

  • 1Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. sreich@som.umaryland.edu

Current Treatment Options in Neurology
|March 27, 2004
PubMed
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Hemifacial spasm (HFS), a nerve disorder, is often caused by cranial nerve compression. Botulinum toxin injections are the preferred treatment due to high success and safety, though surgery offers a potential cure with higher risks.

Area of Science:

  • Neurology
  • Neurosurgery
  • Movement Disorders

Background:

  • Hemifacial spasm (HFS) is a peripheral movement disorder characterized by involuntary contractions of facial muscles.
  • It typically results from compression or distortion of the seventh cranial nerve's root exit zone, frequently by an arterial loop.
  • Other potential causes include tumors, cysts, or aneurysms, necessitating thorough diagnostic imaging, particularly MRI focusing on the seventh cranial nerve.

Purpose of the Study:

  • To review and compare treatment options for Hemifacial Spasm (HFS).
  • To identify the most effective and safest treatment modality for HFS patients.
  • To provide guidance on managing HFS based on current evidence and clinical practice.

Main Methods:

  • Review of existing literature and clinical evidence for HFS treatments.

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  • Evaluation of oral medications, botulinum toxin injections, and microvascular surgical decompression.
  • Consideration of treatment efficacy, success rates, side effect profiles, and potential for recurrence.

    • Main Results:

    • Oral medications, primarily anticonvulsants, show limited efficacy and anecdotal evidence for HFS.
    • Botulinum toxin injections demonstrate a very high success rate with minimal serious side effects, supported by controlled trials.
    • Microvascular surgical decompression offers potential for a cure but involves greater surgical risks and the possibility of spasm recurrence.

    Conclusions:

    • Botulinum toxin injections are considered the treatment of choice for Hemifacial Spasm due to their high success rate and safety profile.
    • Microvascular surgical decompression is a viable alternative for curative treatment, emphasizing the need for experienced neurosurgeons to mitigate risks.
    • All patients diagnosed with HFS require comprehensive evaluation, including MRI, to determine the underlying cause and guide appropriate management.