Hemifacial Spasm

Treatment Options

Hemifacial spasm is treated with medications, botulinum injections and microvascular decompression surgery.

Medications

Medications, including carbamazepine, phenytoin and gabapentin, can relieve involuntary muscle contractions in some patients. These medications were initially developed to treat seizures and must be taken daily.

Botulinum Injections

Another treatment is injection of botulinum toxin type A, which temporarily paralyzes the muscles that are injected. Following injection, usually three to five days are required to quiet the hemifacial spasm. Most patients benefit from the treatment for a few months. Injections are then repeated as needed.

Microvascular Decompression Surgery

Microvascular decompression surgery (removing pressure on small blood vessels) may provide a permanent cure for hemifacial spasm. A neurosurgeon makes a window in the skull bone behind the ear and opens the dura (the covering of the brain) to expose the facial nerve as it leaves the brain stem (the lowest part of the brain that merges with the spinal cord).

Mayo neurosurgeons use both operating microscopes and microsurgical instruments to locate the blood vessel compressing the facial nerve and move it away from the nerve. A Teflon® pad is then placed between the nerve and the vessel, where it remains permanently.

During the procedure, the facial nerve and auditory nerve (hearing) are monitored via electrical signals to safely guide the surgeon.

The surgery completely relieves spasms in approximately 80 percent of patients. The greatest risks from the surgery — loss of hearing and permanent facial weakness — are rare when Mayo surgeons, experienced in this procedure, perform the surgery.