Hemifacial spasm is a rare disorder involving an involuntary contraction of one side of the face which may appear as if the patient is having a seizure, but is usually painless. It can be periodic or become constant, and may be caused by Bell’s Palsy, nerve damage, or the compression of a nerve by a blood vessel or tumor. In the majority of cases, the twitch, when considered typical, begins near the eye then progressively travels downward into the face. In atypical cases, the muscles around the lips contract first, traveling upward. Both have been reported to sometimes worsen in times of stress, anxiety, fatigue or with a change in head position. Hemifacial spasm is seen in both men and women, with a higher rate of occurrence in women older than 44 years of age. If a patient under the age of 40 presents with symptoms, muscular sclerosis should be ruled out.
MRI is the most commonly used test to indicate the reason for the muscle contraction. In mild cases, anticonvulsants or muscle relaxants may provide relief. In more severe cases or if the condition does become painful where Botulinum toxin is not a successful treatment, vascular decompression surgery is considered.
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