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- 5 Most Frequently Asked Questions About Hemifacial Spasm
5 Most Frequently Asked Questions About Hemifacial Spasm
There is a considerable range of treatments that people enter a radiotherapy centre to receive, many of which are for relatively uncommon conditions for which radiosurgery is one of the most effective and least intrusive treatment options.
One of these conditions is hemifacial spasm, a neuromuscular disorder which typically begins with sudden twitches of the eyelid but can spread to the cheekbone and muscles around the lips over time, affecting one side of the full face.
As with many other conditions which cause spasms such as dystonia, it can be somewhat distressing, but hemifacial spasm is treatable, and there are some frequently asked questions for which there are answers, albeit not always conclusive ones.
In all of these cases, however, a compressed facial nerve is at the centre, usually caused by a blood vessel pressing against it. In rarer cases, however, a facial injury which impacts the nerves of the face or even a tumour can be to blame.
It can also be caused as a side effect of Bell’s palsy, a condition which causes temporary paralysis of one side of the face.
In some cases, a doctor cannot find an obvious cause, and these are typically defined as ‘idiopathic’ hemifacial spasm.
As the causes are not genetic, it is not necessarily a hereditary condition, although there has been some research into family members who have each been diagnosed with HFS.
A typical case of hemifacial spasm begins near the eye, often with the lower eyelid before progressing gradually down the same side of the face, from the lips to the cheek muscles.
By contrast, an atypical case starts around the lips or cheekbone and progresses up to the eyelids.
In both cases, it will only affect one side of the face, although there are some extremely rare cases of bilateral hemifacial spasm where it can affect both sides, although only one at a time.
It can affect both men and women, although it is twice as common with women as men, and increases with age, with most people diagnosed between the ages of 45 and 52.
They will, in turn, arrange for a magnetic resonance imaging (MRI) scan or occasionally an angiography. This will help to pinpoint a diagnosis as well as its potential causes, both of which can have an effect on the options that are available for treatment.
However, not everyone can or wants surgery, and an alternative treatment involves the use of stereotactic radiosurgical techniques such as the Gamma Knife.
In cases where hemifacial spasm is caused by tumours, Gamma Knife treatments work to precisely eradicate the tumours that are causing pressure on the facial nerve that has led to the twitches and spasms.
It works in a similar way to radiosurgical treatments for trigeminal neuralgia, where the root caused is effectively excised using pinpoint applications of radiation, either by destroying the tumour causing it or by intentionally damaging the facial nerve to stop it from causing facial contractions.
It has historically been a relatively uncommon course of treatment, with either botox or microvascular decompression surgery the first-line treatments in both cases, but radiosurgery has key advantages compared to both.
The biggest case in its favour is that it is less invasive than surgery, which invariably requires at least one night in a hospital, whilst it has a greater longevity of results than botox, which invariably only lasts a few months before the treatment needs to be repeated.
One of these conditions is hemifacial spasm, a neuromuscular disorder which typically begins with sudden twitches of the eyelid but can spread to the cheekbone and muscles around the lips over time, affecting one side of the full face.
As with many other conditions which cause spasms such as dystonia, it can be somewhat distressing, but hemifacial spasm is treatable, and there are some frequently asked questions for which there are answers, albeit not always conclusive ones.
What Causes Hemifacial Spasm?
The exact cause of a hemifacial spasm is not always easy to diagnose, and the root cause is something that has led to significant debate amongst neurologists, from false synapses to abnormal nerve fibre activity or a damaged facial nerve causing increased activity.In all of these cases, however, a compressed facial nerve is at the centre, usually caused by a blood vessel pressing against it. In rarer cases, however, a facial injury which impacts the nerves of the face or even a tumour can be to blame.
It can also be caused as a side effect of Bell’s palsy, a condition which causes temporary paralysis of one side of the face.
In some cases, a doctor cannot find an obvious cause, and these are typically defined as ‘idiopathic’ hemifacial spasm.
As the causes are not genetic, it is not necessarily a hereditary condition, although there has been some research into family members who have each been diagnosed with HFS.
What Is The Difference Between Typical And Atypical Spasms?
The differences between typical and atypical spasms are generally found in their initial location and how it progresses.A typical case of hemifacial spasm begins near the eye, often with the lower eyelid before progressing gradually down the same side of the face, from the lips to the cheek muscles.
By contrast, an atypical case starts around the lips or cheekbone and progresses up to the eyelids.
In both cases, it will only affect one side of the face, although there are some extremely rare cases of bilateral hemifacial spasm where it can affect both sides, although only one at a time.
Is It Rare?
Hemifacial spasm is a very rare condition, with an overall rate of 0.8 per 100,000 people. Approximately 4,000 people of HFS are currently living in the UK.It can affect both men and women, although it is twice as common with women as men, and increases with age, with most people diagnosed between the ages of 45 and 52.
How Is It Diagnosed?
Typically, a case of hemifacial spasm starts with a trip to a GP for a persistent twitch or spasm. If they cannot find an alternative cause and think it might be hemifacial spasm, they will refer you to a specialist neurologist.They will, in turn, arrange for a magnetic resonance imaging (MRI) scan or occasionally an angiography. This will help to pinpoint a diagnosis as well as its potential causes, both of which can have an effect on the options that are available for treatment.
How Is It Treated With Radiotherapy?
Depending on the cause and severity of hemifacial spasm, a range of different options for treatment are available, including sedation, the anticonvulsant carbamazepine (more commonly used for trigeminal neuralgia), botox or microvascular decompression surgery.However, not everyone can or wants surgery, and an alternative treatment involves the use of stereotactic radiosurgical techniques such as the Gamma Knife.
In cases where hemifacial spasm is caused by tumours, Gamma Knife treatments work to precisely eradicate the tumours that are causing pressure on the facial nerve that has led to the twitches and spasms.
It works in a similar way to radiosurgical treatments for trigeminal neuralgia, where the root caused is effectively excised using pinpoint applications of radiation, either by destroying the tumour causing it or by intentionally damaging the facial nerve to stop it from causing facial contractions.
It has historically been a relatively uncommon course of treatment, with either botox or microvascular decompression surgery the first-line treatments in both cases, but radiosurgery has key advantages compared to both.
The biggest case in its favour is that it is less invasive than surgery, which invariably requires at least one night in a hospital, whilst it has a greater longevity of results than botox, which invariably only lasts a few months before the treatment needs to be repeated.
