What's the treatment for hemifacial spasm?
Treatment usually involves injecting botulinum toxin (Botox) into the affected muscles. Most patients respond favorably to the Botox injections, but in severe cases, surgery may be necessary. Surgery is considered when it is believed that the cause of the spasms is a blood vessel that is pressing on the facial nerve. A neurosurgeon will attempt to reposition the blood vessel away from the nerve.
Botulinum toxin, or Botox, is a protein produced by the C. botulinum bacteria that cause muscle paralysis by blocking the electrical messages that “tell” the muscle to move. Messages are carried by a neurotransmitter called acetycholine. Botox blocks the release of acetycholine; as a result, the muscle doesn’t receive the message to contract. A very fine needle is used to deliver 1 to 3 injections into your facial muscles. Your doctor will decide which muscles. Botox usually works within three days and usually lasts for three months. Botox injections can be repeated indefinitely, however the effectiveness diminishes over the years due to the buildup of antibodies. Side effects include temporary facial weakness, drooping eyelid, eye irritation and sensitivity.
Medications and injections sometimes fail to control spasms or cause side effects. A procedure, microvascular decompression, can relieve the nerve compression. A neurosurgeon makes a hole in the bone (craniotomy) at the back of your head to expose the facial nerve at the brainstem. A Teflon sponge is placed between the offending blood vessel and the facial nerve. About 90% of patients return to their regular life style after two months. Like all surgeries, there are risks. More frequent side effects include decreased hearing and facial weakness. Your surgeon will use intra-operative monitoring of the 7th (facial) and 8th (hearing) nerves during surgery to decrease these complications. In 90% of surgical cases there appears to be a blood vessel compressing the nerve.
Self-help measures such as relaxation techniques appear to help some people, whereas homeopathy, acupuncture and dietary management appear to offer little benefit for hemifacial spasm sufferers. A positive attitude is important. Learning about hemifacial spasm and talking to other sufferers may help you to come to terms with your condition and enable you to find ways of coping with your symptoms. Although hemifacial spasm is not strictly classified as a dystonia, the two conditions have much in common and The Dystonia Society (a registered charity) is a good source of support and information. Support from family and friends is also important. They may also benefit from learning more about hemifacial spasm so that they can better understand your problems.