Microvascular decompression is a treatment option of hemifacial spasm. It relieves the nerve that controls facial muscles from pressure from near by vessel. / Courtesy of Samsung Medical Center

By Noh Hyun-gi

Does your face twitch involuntarily? Or do you suffer from sharp pain that runs through one side of your face throughout the day?

These are easily recognized symptoms of hemifacial spasm and trigeminal neuralgia that affect middle-aged men and women. Though both are easily recognized, myths surrounding the causes lead many to seek unnecessary and ineffective treatment options. They are neurological disorders that can be treated with surgery; in both cases medication do not promise sustainable improvement.

Hemifacial spasm symptoms

Hemifacial spasm refers to unintentional movement of muscles on one side of the face. The contractions start around the eye are and force closure of the eyes. Gradually, the spasm affects lower area of the face. Commonly, the eye muscle movements trigger one side of the mouth to move up simultaneously.

The symptoms occur during sleep and tend to get worse when the patient is nervous, under stress or in a social setting with unfamiliar individuals. The disorder is more common among women than men. According to Samsung Medical Center, which has operated on 1791 individuals with hemifacial spasm since 1997, the average age of the patients was 49.6.

The twitching is limited to only one side of the family – spasm across both sides are extremely are.

Before starting any treatment, differential diagnosis is crucial as multiple disorders exhibit similar symptoms. Blepharospasm brings similar abnormal contractions in the eye lids in elderly. Similar to hemifacial spasm, the twitching gets worse under stress; however they do not persist through sleep and happens in both eyes. Some people show tic and habit spasm, sudden and repetitive moments that may accompany psychiatric conditions such as autism.

Causes

Most hemifacial spasm cases are congenital. In patients afflicted by the sudden contractions, the seventh cranial nerve that controls the facial muscles is disturbed by blood vessels. An artery or vein compresses the nerve eventually causing it to malfunction. In rare cases, magnetic resonance imaging or MRI reveals tumors or other abnormalities pressing the cardinal nerve.

Treatment options

Depending on the severity, patients can undergo medication, botulinum toxin injection (Botox) or surgery.

Antiepileptic, drugs that reduce the epileptic seizures, can be prescribed with muscle relaxers. However, medication does not yield significant improvements in most patients as it manages symptoms and does not alter the root cause.

Similarly Botox injections can decrease the contractions by numbing the facial muscles. The benefits last from two to four months requiring patients must take multiple shots over time. Prolonged use leads people to develop antibodies against the toxin

Park Kwan, professor of neurosurgery at Samsung Medical Center, explained the procedure of microvascular decompression. The surgery makes a two to three centimeter incision on the skull and to expose the nerve situated at the base of the brainstem. Once the compression point is identified, a surgeon separates the vessel from the nerve and places Telflon sponge between the two. Park explained that the operation can last up to four hours; the initial hour is dedicated to securing the patient’s head. Complications include loss of hearing, consequent dizziness, cerebrospinal fluid leak and facial nerve palsy.

Trigeminal neuralgia

Another malady that affects human face is trigeminal neuralgia (TN). This dreadful disorder shoots shocks of pain through the face. The name refers to the three branches of nerves that go through eye, cheek and mouth areas. The pain can last anywhere between second to minutes through the day. Patients have different trigger points or activities such as brushing teeth, speaking, or face washing. The pain is limited to one side of the face at the time. There are two types of

The most common cause is similar to hemifacial spasm – an artery or vein is pressing on the trigeminal nerve in the brainstem.

Differential diagnosis is also necessary to identify TN – other types of neuralgia can exhibit facial spasm with sharp pain. Especially herpes zoster or shingles can cause similar symptoms in the face area.

Medications, surgery, and radiation are treatment options for TN. Anticonvulsants or drugs that block nervous signals as well as pain management drugs such as tricyclic antidepressants. However, eventually patients require surgery. microvascular decompression is used to treat TN as well. More generally for elderly patients who may suffer from complications from full body anesthesia, radiofrequency procedure is recommended. The thermal lesioning involves destroying the trigeminal nerve responsible for pain with electrical current. Thought it avoids full anesthesia, it can cause loss of senses at the operation sight.