Your doctor has diagnosed Hemifacial Spasm,
a chronic condition that affects one side of the face. The patient
with HFS experiences
involuntary contractions, called “spasms,” of the muscles
on one side of the face. The affected side of the face seems to “scrunch
up” while the other side of the face remains normal. The
eye on the side of the spasm closes and the corner of the mouth
tightens and pulls up. The spasm can be brief or sustained, and
can be triggered by facial movement. Middle aged men and women
are affected equally. The spasms persist during sleep. They can
be increased by stress or anxiety and decreased, but not resolved,
by drugs such as lorazepam (Ativan). Some patients have noticed
that alcohol can also decrease the spasms, but the amount of alcohol
required makes this undesirable as a treatment.
HFS is thought to be caused by a blood vessel
lying on the facial nerve where it enters the brain. Surgery
can sometimes help, consisting
of placing a small sponge between the nerve and the artery (“facial
nerve decompression”), but the safest treatment is by injections
of botulinum toxin, called “BOTOX.”
Hemifacial Spasm
Botox injection sites for HFS
Botulinum Toxin
Botulinum toxin, called “BOTOX,” is an effective treatment
for hemifacial spasm. A tiny drop of BOTOX is injected under the
skin at each affected site. In a few days the BOTOX takes effect,
relaxing and weakening the facial muscles and preventing spasm.
Many ophthalmologists and neurologists perform BOTOX injections
for HFS. The injections are done in the doctor’s office and
usually take only 5 or 10 minutes. The effect wears off in about
3 months and the injections must be repeated. Most patients have
no side effects from the injections but minor bruising can occur
at the injection sites and temporary lid drooping and double vision
occasionally occur.
Facial Nerve Misdirection Syndrome
Facial Nerve Misdirection Syndrome is a condition similar to HFS
caused by nerves making wrong connections when they grow back after
facial nerve palsy sometimes called “Bell’s palsy.” Most
of the time, the nerves grow back and re-establish their connections
with the original muscles. But sometimes the growing nerves connect
to the wrong muscle instead of or in addition to their correct
connections. In those cases, firing of the facial nerve results
in contraction of the wrong muscle or of wrong muscles in addition
to the intended muscle. This misdirection causes the mouth to move
when the patient closes his eye or causes the eye to close when
he smiles or purses his lips. Selective injection of BOTOX can
interrupt or block the aberrant messages and return specificity
of function.
Frequently Asked Questions
Can I catch botulism from the BOTOX shots?
No. BOTOX is injected just under the skin and does not affect the
rest of the body. The small amount of botulinum toxin injected
is a fraction of the dose that causes botulism.
Do the shots hurt?
BOTOX is injected through a very tiny needle to avoid pain. Most
patients report only mild discomfort lasting seconds.
