Hemifacial spasm

Diagnosis

Diagnosing hemifacial spasm typically starts with discussing your medical history. Your healthcare professional asks about your symptoms, including how long you've had them. Your healthcare professional also may perform physical and neurological exams to check muscle movement and look for other nerve issues.

You may have imaging tests such as magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create detailed images of the head. This can help show blood vessels pressing on the facial nerve. It also can show tumors or brain conditions.

Sometimes, you may have magnetic resonance angiography (MRA). During an MRA, a dye is put into the blood vessel to show whether it is touching the facial nerve.

Your healthcare professional may perform electromyography (EMG) though it's not commonly needed. An EMG measures electrical activity in the facial muscles. The test tells your care team whether nerves and muscles are sending and receiving signals as they should.

Diagnosing hemifacial spasm doesn't always need imaging tests. They are more likely if symptoms aren't typical or if your care team is planning surgery.

Treatment

Treatment for hemifacial spasm may include:

• Oral medicines. Some medicines, such as antiseizure medicines and muscle relaxants, can relieve hemifacial spasm in some people. These medicines are used mainly in early or mild hemifacial spasms.
• OnabotulinumtoxinA injections. A shot of onabotulinumtoxinA (Botox) into the affected muscles keeps the muscles from moving. This treatment needs to be repeated every few months to control spasms. It is the most common treatment and controls symptoms in most people.

• Surgery. There are different types of surgery to help relieve hemifacial spasm. Studies have found that microvascular decompression (MVD) surgery is the most effective and long-term treatment. During MVD surgery, the surgeon makes an incision behind the ear to reach the brain. The surgeon places a small spongelike pad between the blood vessel and the facial nerve to relieve the pressure.

  Recent research has found that endoscopic assistance may make the surgery more successful.

  Other surgical treatments may include nerve massage, heat or high-frequency pulses of electricity to lessen feeling in affected nerves. Cutting or removing all or part of the nerve also may be an option. Radiofrequency thermocoagulation is another procedure that destroys parts of the facial nerve with heat and radio waves.

• Acupuncture. Some studies have reported that acupuncture can treat symptoms of hemifacial spasm. More research is needed to learn about the effectiveness of this alternative medicine.