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Hemifacial Spasm

Hemifacial spasm is an involuntary contraction of the facial muscles on one side of the face. The patient complains mainly of twitching around one eye, as if winking. Reading or sewing for example becomes very tiring. The twitches spread to the cheek and the corner of the mouth, changing the expression of the face, with major social embarrassment. Difficulty falling asleep can occur also because twitches may be felt inside one ear. Brain MRI shows in most of the cases a compression of the facial nerve by an arterial loop.


Botulinum toxin injections have been used since 1986 for the treatment of hemifacial spasm. The Botulinum toxin injections in the facial muscles need to be repeated every 4 months on average. The other therapeutic option is a microvascular surgical decompression. Usually, patients are advised to start with Botulinum toxin injections, but in cases of incomplete response or difficulty with regularly repeated injections, surgery can be discussed with the patient.

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