Hemifacial Spasm

Treatment Options

Medications (including carbamazepine, phenytoin and gabapentin) are one option for treating hemifacical spasm. Initially developed for seizures, these medications can help allieviate spasms in some patients. They must be taken daily.

Another treatment is injection of botulinum toxin type A (Botox), which paralyzes the muscle. It usually takes about three to five days to quiet the spasm. In some patients with mild spasms, the effects can last many months. Injections can be repeated.

Microvascular decompression surgery can be a permanent cure for HFS. In this surgery, the 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 brainstem. This is done with the help of an operating microscope and microsurgical instruments. The goal of the surgery is 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. The pad remains permanently. During the procedure, the facial nerve and auditory nerve (hearing) are monitored via electrical signals to safely guide the surgeon in the operation. The surgery completely relieves spasms in about 80 percent of patients. The biggest risks from the surgery (both rare with surgeons experienced in this procedure) are loss of hearing and permanent facial weakness.