Have you ever felt a sudden twitching sensation around your eyes or cheeks while you were laughing or talking to someone, or when you were feeling a little tired? This uncontrollable twitching of the muscles on one side of your face can be a bit annoying and embarrassing. While many people think this is normal, sometimes it can be a medical emergency. Today we are talking about one such condition, Hemifacial Spasm (HFS).
What exactly is Hemifacial Spasm?
Simply put, Hemifacial Spasm (HFS) is a neurological condition that causes involuntary muscle twitches on one side of your face. This is a symptom that usually gets worse over time.
If you look at the meaning of the name, “Hemi” means “half.” “Facial” means “pertaining to the face.” “Spasm” means “muscle spasm.” So “Hemifacial Spasm” means “muscle spasm in half of the face.”
This condition usually begins in adulthood, between the ages of 40 and 60. Doctors call it a peripheral movement disorder. That is, a problem with the peripheral nervous system, which is the part of the nervous system outside our brain and spinal cord.
Hemifacial Spasm is a relatively rare condition, and women are twice as likely to develop the condition as men.
Are there main types of this condition?
Yes, there are two main types of this, depending on how the symptoms develop over time. To understand this clearly, see the table below.
| Type of Hemifacial Spasm | How the symptoms manifest |
|---|---|
| Primary Hemifacial Spasm | In this type, the muscles around the eyes begin to twitch first. It may take months or years for the twitching to spread to the muscles in the lower part of the face. |
| Secondary Hemifacial Spasm | In this case, the muscle twitching in both the upper and lower parts of the face begins at about the same time. Although this twitching may come and go at first, it will start to occur more frequently over time. |
What are the symptoms of facial flushing?
The main symptom of this condition is a twitching of the muscles on one side of the face. This is involuntary (we cannot control it). This twitching is more common on the left side than the right side. However, very rarely, this twitching can occur on both sides of the face.
The first symptom usually starts with eyelid twitching. This comes and goes. Over time, symptoms may progress to:
- Involuntary blinking: It's like blinking, but we can't control it.
- Eyebrow lifting: The eyebrow automatically goes up due to the stroke.
- Lower facial swelling: This can cause the mouth to be pulled to one side.
- Affecting all the muscles on one side of the face: In some cases, this twitching can be continuous and unremitting.
The important thing is that this muscle spasm is usually not painful. However, when you are in public, it can make you feel uncomfortable and embarrassed.
These symptoms can be exacerbated by things like stress, fatigue, eating, and anxiety. Surprisingly, these attacks can also occur while you're sleeping. This can even lead to insomnia in some people.
Other symptoms
Some people may experience other things in addition to these main symptoms.
- Hearing a "clicking" sound inside the ear.
- Ear pain.
- Hearing impairment (especially in secondary HFS).
Why is this happening? What are the reasons?
The main cause of hemifacial spasm is prolonged pressure on one of our facial nerves (the seventh cranial nerve). However, there can be several other underlying causes for this pressure.
There are two main nerves on each side of our face. This nerve starts in our brainstem and branches out along one side of the face. It controls things like the muscles that control facial expressions, the salivary glands in the mouth, the tear glands in the eyes, and the taste buds on the front two-thirds of the tongue.
The causes may vary depending on the type of HFS.
Causes of Primary Hemifacial Spasm
This is the most common cause. What happens here is that an abnormally positioned blood vessel presses on the facial nerve. This pressure gradually wears away the protective covering (myelin sheath) of the nerve. Then, nerve signals do not travel properly, misfire, and the muscles start to twitch.
Causes of Secondary Hemifacial Spasm
This is when the facial nerve is affected by another underlying condition or problem. Some of the causes include:
- An accident or injury near the facial nerve.
- Bell's palsy condition.
- Damage to the brainstem, for example, conditions such as multiple sclerosis or stroke.
- Problems with blood vessels in the brain, such as brain aneurysms and non-cancerous blood vessel tumors (angiomas).
- Ear problems. Conditions like middle ear infections (otitis media), mastoiditis.
- Tumors that occur in the salivary glands (parotid glands).
- Structural problems that occur in the back and lower part of the skull.
How does a doctor find this?
If you have these symptoms, when you see a doctor, he will first examine you physically and perform a neurological exam.
Then, an MRI scan is often recommended to rule out other causes of your symptoms and to find the exact cause of your HFS. In primary HFS, an MRI scan can usually detect the abnormal blood vessel that is pressing on the nerve.
Sometimes these muscle spasms can resemble other types of facial spasms (e.g. blepharospasm) or seizures. Therefore, if your doctor is unable to accurately identify the type of spasm, he or she may recommend an electromyography (EMG) test.
What are the treatments for this?
The main goal of treatment is to reduce the frequency and severity of facial flushing. Treatment options depend on the cause and severity of the condition. Let's take a look at the main treatment options.
| Treatment method | Description |
|---|---|
| Botulinum toxin (Botox®) injections | This is the most commonly used first-line treatment. It involves giving an injection to temporarily weaken the muscles that cause the spasms. It usually lasts for 3-4 months, after which the injection must be repeated. |
| Oral medications (pills) | These are given to people who do not want Botox injections or cannot undergo surgery. These include medications such as anticonvulsants and muscle relaxants. |
| Surgery | This is the only permanent solution for HFS. A surgical procedure called Microvascular Decompression removes the blood vessel that is pressing on the nerve and inserts a pad. This is only recommended for severe cases. |
Botox Injections (Botulinum Toxin Injections)
Botox injections are considered the first-line treatment for HFS due to their effectiveness and low side effects. Symptoms can be reduced within three to six days of the injection. However, the effects last for about three to four months. After that, you will need to get the injection again to control the tics.
Minor side effects may occur after this injection:
- Eye irritation
- Eyelid drooping
- Temporary facial weakness
Oral Medications
The doctor may prescribe medications like these:
- Antiepileptics such as carbamazepine or gabapentin.
- Benzodiazepines such as clonazepam.
- Muscle relaxants such as baclofen.
Although these medications can help reduce heart rate, they do not work for everyone. Also, long-term use can cause side effects such as drowsiness and fatigue.
Surgery
As we mentioned earlier, the only way to permanently cure HFS is through surgery. However, doctors only recommend this if the condition is very severe and Botox injections are not effective.
The most common surgery is called microvascular decompression . This involves releasing the blood vessel that is compressing the nerve from the nerve and placing a small Teflon pad between the two.
If this surgery is successful, you will never have to suffer from HFS again. But like any surgery, there are some risks.
- Reactions to anesthesia.
- Temporary or permanent damage to the facial nerve.
- Hearing impairment.
- Cerebrospinal fluid (CSF) leak.
Is this a dangerous situation? Should I be afraid?
No. Hemifacial Spasm itself is not harmful to your physical health. However, sometimes the underlying medical condition that causes it (e.g., a brain tumor, brainstem damage) can be dangerous.
That's why it's essential to see a doctor as soon as you experience these symptoms and find the exact cause.
In addition, you may experience complications such as:
- Sleep problems.
- Mental health problems, such as social isolation, anxiety, and depression.
- Uncontrolled eye closure for a long time. This can be dangerous if it happens, such as while driving.
Hemifacial Spasm is a very annoying and embarrassing condition. The feeling of not being able to control your body is not good for anyone. But the good news is that there are effective treatments for it, such as Botox injections, medications, and surgery. If you also experience facial spasms frequently and feel that they are getting worse, definitely see a doctor. He will do the necessary tests and give you the most suitable treatment plan.
Take-Home Message
- Hemifacial Spasm (HFS) is a neurological condition that causes the muscles on one side of your face to twitch uncontrollably.
- This is often caused by a blood vessel pressing on a facial nerve, but there can be other serious causes as well.
- Although this pain is usually not painful, it can affect daily life and mental health.
- There are very effective treatments for this, such as Botox injections, medications, and surgery.
- If you have symptoms like these, it is very important not to panic, but to see a doctor immediately for a proper diagnosis and treatment.
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