Hemifacial Spasm

Imagine your face moving, day and night, uncontrollably. Individuals with hemifacial spasm report the onset of spasms about the eye and the progression of spasms to involve all of the facial muscles over time. Immediately, you wonder if you’re having a serious neurological problem, but a trip to a local emergency department assures you that you are not. Most often, you are told, “It’s just stress…relax.” But, you’re not experiencing more stress than usual. Your family and loved ones tell you that they don’t notice anything with your face. They love you. When you’re in public, children stare, adults sometimes look away. Over time, the spasms create a kind of ongoing fatigue in the face. Very often, patients diagnose themselves by reading the stories of other individuals on the internet.

Over the years, the stories that I heard from patients range from funny to heartbreaking, most often the latter. One woman, who worked at a local sporting goods store, told me that she went for surgery twice without success. Over time, she asked the owner of the store if she could work in the back room so she could avoid customers. When she first called us, she was frightened of a third surgery. She’d already lost the hearing in one ear, and her balance was off. Eventually, she sent her MRI to us, and we noted that the artery compressing her facial nerve was still impinging the nerve. The third surgery was a success. I don’t wish to reveal her identity with any more specifics, but I can tell you that she now runs her own very successful business. Hemifacial spasm was robbing her of her hopes and dreams.

More often, patients are told by other doctors that, “nothing can be done” except botulinum toxin injections. While I don’t have a problem with botulinum toxin injections, that treatment essentially trades spasms for weakness…when it works at all. Most individuals, if they even know about the surgery, worry that the risks outweigh the benefits. One patient, the husband of a doctor, reported to me, “My wife said, ‘Why undertake a life-threatening operation for a non-life-threatening condition?’” This is an understandable reaction from a loved one. But, few individuals really understand how debilitating hemifacial spasm is for the sufferer.

Over the years, I’ve performed more than 1300 microvascular decompressions for hemifacial spasm with nearly 90% of patients reporting complete relief of spasms at long-term follow-up. There are risks to the operation, but in experienced hands, the risks are low, and the rewards are high. Recently, a patient who underwent microvascular decompression surgery wrote to me, “You have proved yourself a hero and a gem in my life. I have my life back.”