Facial Spasms
There are several different types of facial spasms. Dr. Mettu performs a careful evaluation to make the correct diagnosis and prescribes a treatment plan accordingly. Benign Essential Blepharospasm, Hemifacial Spasm, Aberrant Regeneration of the Facial Nerve, and Orbicularis Myokymia are described below.
Benign Essential Blepharospasm (BEB)
BEB is a poorly understood, often debilitating movement disorder in which patients experience spasms of the muscles of eyelid closure on both sides without any apparent cause. In the early stages, the disease may appear as frequent blinks. The diagnosis may not be obvious to a provider who is not familiar with this condition. Patients frequently have associated light sensitivity. There is no treatment to prevent the abnormal signal causing the spasms (i.e. there is no oral medication that is effective). Thus, the mainstay of treatment is Botulinum/Xeomin injections to weaken the muscles undergoing spasms. Injections are typically repeated around every three months. Watch the video below to see how injections can help. Oromandibular dystonia (also known as Meige Syndrome) is a variant of BEB that involves lower face movement.
Hemifacial Spasm (HFS)
HFS is a condition characterized by increased activity of the facial nerve which leads to spasms on one side of the face. The cause is most commonly due to contact between a vessel and the facial nerve where it exits the brainstem. An MRI is typically performed to ensure there is not an alternate source of facial nerve dysfunction, which is rare. While a neurosurgical procedure (microvascular decompression) is an option for some patients with HFS, Botulinum/Xeomin injections are often favored by many patients because the injections are well tolerated and highly effective. The injections last for approximately 4-6 months.
Aberrant Regeneration of the Facial Nerve
Aberrant regeneration of the facial nerve is a miswiring of the nerve as it recovers after facial nerve palsy from various causes including Bell's palsy. Patients who have aberrant regeneration of the facial nerve may have unwanted movements of the face. For example, with a blink, the lower face on the same side may move. Another example is a patient who has tearing when eating (gustatory tearing also known as crocodile tears). Botulinum/Xeomin injections can be given to decrease tone in affected muscles. Additionally, Botulinum/Xeomin can be injected directly into the lacrimal gland for patients with gustatory tearing.
Orbicularis Myokymia
Orbicularis myokymia (also known as eyelid myokymia) is a condition in which the eyelids twitch (usually one side at a time) for seconds to days, resolving independently. Common associated factors include decreased sleep and increased caffeine intake. Rarely, the condition can have a prolonged course in which case neuroimaging may be indicated to exclude hemifacial spasm. This is done because hemifacial spasm may initially present with eyelid spasms before the lower face becomes involved. In the rare cases of prolonged orbicularis myokymia, Botulinum/Xeomin injections can be given.