Childhood-onset hemifacial spasm: successful treatment with botulinum toxin

Hemifacial spasm is a disorder characterized by involuntary contractions of muscles innervated by the ipsilateral facial nerve. The majority of cases are of adult-onset. However, a few cases have been described in children. Detectable causes of pediatric hemifacial spasm include facial nerve compression by vasculature and brainstem masses. In the treatment of hemifacial spasm, surgical decompression of the facial nerve has been used with good results in both adults and children. However, surgical procedures have serious risks and should be used only in selected cases. Although injections of botulinum toxin type A have been successfully used in adult hemifacial spasm patients, to our knowledge there is no report of use of this indication in children. This report presents the first case of a pediatric patient with childhood-onset hemifacial spasm successfully treated with periorbital botulinum toxin injections. The literature on the subject is also reviewed.