Features of Hemifacial Spasm

Spina Bifida

Our face is the window we present to the world and when something goes wrong with the face, it leads to a whole lot of mental agony and embarrassment.

Spasms usually refer to a sudden involuntary contraction of a muscle or a bunch of muscles, but when we talk about hemifacial spasm, we are talking about half a face getting affected, and that’s a lot of area to go into spasm!

This painless involuntary twitching occurs due to malfunctioning of the seventh cranial nerve; this facial nerve plays an important role in facial muscle movement, stimulation of the salivary and tear glands as well as controlling two-thirds of the tongue’s taste buds and a muscle involved in hearing. Now if something goes wrong with one of these facial nerves that run along each side of the face, it results in involuntary twitching of the face, starting from the eyelids, then spreading to the cheeks, nose and mouth; in a social set-up, it leads to a lot of demoralizing embarrassment to the person and may even resemble a seizure as the twitching progresses from being intermittent to becoming almost continuous.

The facial nerve originates deep inside the brain and passes through a myriad of structures to reach the face; along the way, if something presses on it, it can affect the signals being sent to the face and lead to blinking, nose twitching and pouting lips along with facial distortion.
Initially the twitching and spasm may come and go, but with time the face may go into a permanent spasm with the left side being more affected than the right. It’s been noted that stress and fatigue may worsen the twitching episodes, with improvement occurring once the person lies down and relaxes.

This rare neuromuscular disease is more common in middle-aged and older women as compared to men and is more common in some Asian communities. It occurs in two forms: typical and atypical. In the typical form the twitching starts from the lower eyelid and progresses downwards towards the lips; in the atypical form the twitching starts from the lips and progresses upwards towards the eyelid.

The causes for this condition are largely unknown and thought to be due to compression from a blood vessel or tumor or in rare cases, due to infections or stroke.

Treatment for mild cases can include anti-epileptic medications that calm nerve impulses. Injections of controlled doses of botulinum toxins can also be used to block nerve signals and weaken spasms. Where spasms have become debilitating and unresponsive to medical management, surgical interventions like micro-vascular decompression are carried out.

Since this is a long-term, non-fatal disease affecting the quality of life, learning relaxation techniques and staying positive can be beneficial.

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