Hemifacial Spasm

Hemifacial spasm is a condition involving repetitive spasm of one side of the face that can be treated by a neurologist with botox injections, but can often be cured with a surgical procedure called microvascular decompression.

What is the cause of hemifacial spasm?

In almost all cases hemifacial spasm results from the presence of an artery that is “pushing” on the facial nerve as it exits the brain. This may be because of the particular anatomy of the affected person but also because as we age our arteries stretch out somewhat.

What are the treatments for hemifacial spasm?

The initial treatment is usually to use botox injections which block the muscle and aim to stop the twitching. They can induce some weakness in the facial muscle due to their mechanism of action but any side effects (and benefits!) tend to wear off over about 3 months and therefore repeated administrations are required.

The definitive surgical treatment is an operation called microvascular decompression (MVD). This involves repositioning the artery that is pressing on the nerve. The operation requires a 2-3 day hospital stay including 1 night in intensive care. Typically people will be up and about the day after the operation. The cut in the skin is made just behind the ear and there will be some pain in that location for a few weeks following surgery, though it is usually manageable with tablet medications such as Panadeine forte.

How long does it take to get over the surgery?

Typically a patient will be up and about the next day after surgery, home within 2-3 days. After that walking is good exercise but it is recommended to take things easy over the first few weeks, avoiding heavy exercise at the gym and so forth. Return to work, if applicable, is recommended to be at around 4-6 weeks after surgery. It is normal to feel quite tired for even a few months after going through surgery.

Will the spasms stop immediately?

The spasms sometimes stop immediately and sometimes gradually ease off over several weeks or even a few months.

What are the risks of surgery?

A detailed discussion of risks would occur during the consultation. The specific risks (each of which is uncommon) include causing facial weakness, hearing loss or balance (vestibular problems). The hearing nerve is continuously monitored during the surgery. There is a small chance (approximately 1 in 100) of developing a CSF leak (clear fluid running from the nose) which would require a second (brief) operation to repair if it occurred. All operations also carry risks such as infection, bleeding and those related to having an anaesthetic. The risks listed here are general and if contemplating surgery you should have a specific discussion with Dr Jonker.

How effective is surgery?

The operation is successful in stopping the spasms in approximately 85% of cases. There is a small rate of recurrence over time, but the majority of patients once successfully undergoing the MVD operation will be free of their hemifacial spasm for the rest of their life.

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