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Hemifacial Spasm - Mayo Clinic

hello my name is dr. Michael link I'm a

neurosurgeon at the Mayo Clinic in

Rochester Minnesota I'm going to discuss

just a little bit about hemifacial spasm

hemifacial spasm is really quite a rare

disorder the exact etiology is not known

but it presents usually starting is just

a faint twitching around one eye and

then over time and typically spreads to

involve the entire face and produces a

very characteristic Aric turistic

rhythmic twitching of the face that

initially may be only noticeable to the

patient but eventually becomes quite

obvious even a casual observer it's

typically a not painful not associated

with any sensory changes or numbness of

the face but as it gets more progressive

it can certainly interfere with daily

life can interfere certainly in social

situations but also even with reading or

trying to watch TV

if the face is constantly twitching or

pulling up there's no specific way to

diagnosis other than looking at the

patient and seeing the twitching of the

face sometimes an electrical test called

an electro Maya graph or EMG can be

helpful in finding the characteristic

electrical findings on that test an MRI

scan is often performed to make sure

there's no underlying cause such as a

benign tumor which would be very very

rare typically what we think the cause

is is a normal artery of the brain that

has gotten elongated and is pushing on

the facial nerve

the treatments fall into three big

groups one option is medical treatment

with medications that sort of calm the

nervous system down these are

medications that were initially

developed to treat seizures tegretol or

carbamazepine is one example neurontin

or gabapentin is another example

sometimes those are effective a simple

way to treat the symptoms with botulinum

toxin injections into the muscles of the

face or Botox while that doesn't stop

the electrical discharge from the nerve

masks the symptoms by calming the

muscles down in the face some patients

only need those injections you know a

couple times a year sometimes if the

spasm is quite severe and progressive

they need to have them much more

frequently the only real definitive

treatment is an operation in which we go

in and actually look at the facial nerve

and look for that artery pushing on the

nerve if we're able to find that and we

move the artery away we Pat it up with

some Teflon felt and in about 70 percent

of patients the twitching goes away

there's obviously some risk with

undertaking that operation but the risks

aren't great then once again the success

rate is about 70 percent although a rare

disorder we have a fairly extensive

experience here at Mayo Clinic and we

work as a multidisciplinary team

involving the neurologists and

neurosurgeons