Hemilic spasm

What is hemilic spasm?

Hemilic facial spasm is a disorder characterized by paroxysmal involuntary twitching of the muscles of the half of the face innervated by the facial nerve of the affected side.

Types and causes of hemilic spasm?

Depending on the cause, hemilic spasm can be primary or secondary. In 97% of cases of primary hemilic spasm, the cause is a nearby artery, which pulsates, periodically irritating the nerve, which causes spasm of facial muscles. Secondary hemilic spasm develops due to other diseases or conditions, such as:

  • trauma
  • Bell’s palsy or idiopathic (of unknown origin) facial paralysis
  • brainstem lesions, such as multiple sclerosis, stroke
  • arteriovenous anomalies, intracranial arterial aneurysms, arterio-venous fistula, angiomas
  • infections of the mammary gland and ear (otitis media, cholesteatoma)
    parotid tumors
  • Arnold-Chiari anomaly and other structural anomalies of the posterior cranial fossa.

What are the symptoms of hemilic spasm?

In the initial stages of primary hemilic spasm, twitching of the circular muscle of the eye is characteristic, possibly even to its involuntary closure. As the disease progresses, the spasm spreads to the lower muscles (circular muscle of the mouth, chin, subcutaneous muscle of the neck). Also, after a long course of the disease, it is possible to form muscle contracture of the affected side of the face, keratitis with the transition to pain in the eye with loss of vision, the formation of saliva from the corner of the mouth with permanent loss of saliva.

The slightest irritation, emotional fluctuations, eating, talking can provoke spasms.

In secondary hemilic spasm, as a rule, twitching occurs immediately in both the upper and lower part of the face.


In the presence of the above symptoms, you should first seek the advice of a qualified specialist to confirm and clarify the diagnosis, clarify the cause with MRI in special modes. Secondary hemilic spasm requires treatment of the actual primary disease that led to its occurrence.

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There are currently 3 treatment options for primary hemilic spasm:

Option 1: Drug treatment.

It is used in the case of a mild course of the disease and in its early stages. It is based on the use of drugs that disrupt the conduction / reduce the number of pathological impulses in the facial nerve, which in turn reduces spasm. However, medications can have side effects such as drowsiness, nausea, lethargy, and occasionally fatigue.

Option 2: Botulinum toxin injections.

Botulinum toxin injected into a muscle blocks the transmission of a nerve impulse, thereby “switching off” the muscle. The effectiveness of this method is high – 85-95%, but the duration of the effect is 3-4 months, then repeated injections are required, but there were cases after 8-10 injections of the development of nerve paralysis without the possibility of its recovery.

Option 3: Surgical treatment – microvascular decompression of the facial nerve root.

The operation is the removal of a vessel that compresses the nerve, the installation of a special Teflon gasket between the vessel and the nerve. As a result, the vessel no longer comes into contact with or irritates the nerve. The peculiarity of this treatment option is that in this way we act on the cause of the disease, curing it, and not treat the symptoms, as in the previous two options.

The specialists of our clinic will not rush with the operation. Your case will be diagnosed. You will be able to ask questions and get a full consultation.

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