The symptoms of Hemifacial Spasm develop gradually and almost always affect only one side of the face. As explained by Dr. Jaydev Panchwagh and detailed on sites like neurosurgerypune.com:

• Initial Twitching: It typically begins with a subtle, intermittent twitching of the eyelid or around the eye (orbicularis oculi muscle).
• Progressive Spread: Over time, the spasms progressively spread downwards to involve other muscles on the same side of the face, including the cheek, around the mouth (e.g., pulling the corner of the mouth), and sometimes even the platysma muscle in the neck.
• Involuntary and Uncontrollable: The spasms are entirely involuntary, meaning the patient cannot control them.
• Variable Intensity: The severity and frequency of the spasms can vary. They often become more noticeable and frequent with stress, fatigue, anxiety, bright lights, or even talking and smiling.
• Presence During Sleep: Some patients may experience these spasms even during sleep, and some may have a disturbed sleep because of them.
• No Pain (Usually): Unlike Trigeminal Neuralgia, Hemifacial Spasm is generally not painful, although some patients may experience a pulling sensation or mild discomfort due to continuous muscle contractions. Many patients, especially those with severe hemifacial spasms, report facial fatigue caused by constant muscle overactivity.

The constant twitching can lead to significant functional and cosmetic issues, impacting vision (if the eye repeatedly closes), eating, speaking, and leading to considerable social anxiety and emotional distress.

As mentioned, the overwhelming majority of Hemifacial Spasm cases are caused by compression of the facial nerve by an aberrant blood vessel (artery or vein) at its exit zone from the brainstem. The pulsating vessel causes chronic irritation and demyelination (damage to the nerve’s protective sheath), leading to abnormal electrical signals.

Other less common causes or contributing factors include:

• Facial Nerve Injury: Previous trauma or injury to the facial nerve.
• Tumors: Very rarely, a tumor in the cerebellopontine angle (CPA) region may cause facial nerve compression directly or indirectly.
• Multiple Sclerosis (MS): In rare instances, HFS can be a symptom of MS.
• Aneurysms or Arteriovenous Malformations (AVMs): In extremely rare cases, a vascular anomaly other than a normal blood vessel might cause facial nerve compression.

Age is also a factor, as HFS typically begins in middle to older age, likely because blood vessels can become more tortuous and stiff with aging, increasing the likelihood of nerve contact.

Diagnosing Hemifacial Spasm: It is primarily a clinical diagnosis based on the characteristic symptoms reported by the patient. Dr. Jaydev Panchwagh emphasizes a meticulous review of the patient’s history and a thorough examination:

• Detailed Medical History and Symptom Assessment: The neurosurgeon will carefully listen to the patient’s description of the twitching, including its onset, progression, triggers, and impact on daily life. Observing the spasms during the consultation is often highly diagnostic.
• Neurological Examination: A comprehensive exam to assess facial nerve function, identify any associated weakness or numbness, and rule out other neurological conditions.
• Imaging Tests (MRI): An MRI of the brain, specifically with sequences designed to visualize the facial nerve and surrounding structures (like high-resolution FIESTA or CISS sequences), is crucial. This specialized MRI helps to:
  • Confirm Vascular Compression: It can often identify the specific blood vessel compressing the facial nerve, providing direct evidence for the most common cause.
  • Rule Out Other Causes: It is vital to exclude less common causes such as a tumor, cyst, or multiple sclerosis lesion that might be compressing the nerve.
  • Aid Surgical Planning: If Microvascular Decompression (MVD) is being considered, the MRI provides precise anatomical details for the surgeon.

While Electrography (EMG) or nerve conduction studies might be performed in some cases to confirm nerve dysfunction, the clinical picture combined with a high-resolution MRI is usually sufficient for accurate diagnosis.

The goal of Hemifacial Spasm treatment is to stop the involuntary spasms and improve the patient’s quality of life. Treatment options range from temporary solutions to a potentially permanent cure, with Dr. Jaydev Panchwagh advocating for the most effective long-term solution based on his extensive experience.

1. Medication: (Limited Use*)
   • Oral Medications: Anticonvulsant medications (like Carbamazepine, Clonazepam, Gabapentin) or muscle relaxants (like Baclofen) are sometimes prescribed to help reduce the severity or frequency of spasms.
   • Limitations: While they may offer some initial relief, they often have limited long-term efficacy, requiring increasing doses which can lead to significant side effects such as drowsiness, dizziness, and cognitive impairment. Medications do not address the underlying cause.
2. Botulinum Toxin (Botox) Injections: (Limited Use*)
   • Temporary Relief: Botox injections are a very common treatment. Small amounts of Botox are injected into the affected facial muscles, temporarily paralyzing them and stopping the spasms.
   • Limitations: The effect is temporary, typically lasting for 3-6 months, after which repeat injections are necessary. It addresses the symptom (muscle contraction) but not the underlying cause (nerve compression). Over time, repeated injections can lead to facial weakness or asymmetry.
3. Surgical Option (Best Option for potentially Permanent Cure):
   • Microvascular Decompression (MVD) Surgery:
     • The Gold Standard and Potentially Curative: MVD is the definitive and most effective long-term treatment, often offering a permanent cure for Hemifacial Spasm. Dr. Jaydev Panchwagh is a globally recognized authority in MVD surgery, having performed over 2900 MVD procedures for both Trigeminal Neuralgia and Hemifacial Spasm, positioning his center as a “Centre of Excellence” for these conditions.
     • How it Works: Similar to MVD for Trigeminal Neuralgia, this highly specialized neurosurgical procedure is performed under a high-power operating microscope. A small opening is made behind the ear. Dr. Panchwagh then carefully identifies the blood vessel (usually an artery) that is compressing the facial nerve at its exit from the brainstem. This vessel is gently moved away from the nerve, and a small, inert, permanent Teflon sponge is inserted between them to keep them separated, thereby relieving the pressure and allowing the nerve to heal. Where anatomically possible a sling may also be created to change the direction of the blood vessel.
     • Benefits: MVD aims to address the root cause of the problem. It offers immediate or rapid relief from spasms in a very high percentage of patients (often over 90-95%) with a high success rate for long-term or permanent resolution. Crucially, it preserves facial nerve function, minimizing the risk of permanent facial weakness or paralysis, and allows patients to potentially stop medication. Dr. Panchwagh’s extensive experience significantly contributes to the high success rates and patient satisfaction.

*Limited Use: This indicates a potentially temporary solution, and after the treatment, there is a higher chance of symptom or disease recurrence.