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Suggest remedy for hemifacial spasm

Answered by
Dr. Neeraj Kumar


Practicing since :2006

Answered : 2263 Questions

Posted on Fri, 23 Oct 2015 in Brain and Spine
Question: I have a spasm on the right side of my face. For the last 12 months, it occurs 4 or 5 times a day and may last an hour or more. Sometimes it is so severe that can't read out of my right eye. I've had an MRI and a neurologist and surgeon said the test showed that a vessel supplying the back part of my brain is contacting a nerve bundle that controls muscle movements on right side of my face. The adjacent nerve bundle also connects to the right ear. The doctor offers this surgical solution: Entering the skull from behind the right ear, installing Teflon pillows to separate the vessel from the nerve bundle or, if necessary, attach the artery to the inside of skull away from the nerve bundle. He said the surgery carries a five percent risk of: stroke, infection, aggravating the condition or failing to correct the condition. It seems to me the risk-benefit ratio does not favor surgery.
Answered by Dr. Neeraj Kumar 2 hours later
Brief Answer:
Medicines, botox can be tried before surgery

Detailed Answer:
Hello xxxxx,
I have gone through your question and understand your concerns.
The condition and symptoms you are describing points to diagnosis of hemifacial spasm.
The pathology and pathophysiology postulated in most cases is nerve compression intracranially after exit from brainstem due to vascular loop. In some cases no apparent cause can be found.
The treatment is either medical or surgical.
The surgical treatment is as advised by your doctor.
The medicine like clonazepam, baclofen , carbamazepine can be tried.
Another approach is use of botulinum toxin injections over face muscle to get it paralyzed temporarily .The benefit is usually for 6 months and has to be repeated.
You can visit a neurologist and discuss about medicine first. In case you are not getting satisfactory benefit from drugs you can opt for surgery.
Hope you found the answer helpful.
Do get back with further queries.
Dr Neeraj Kumar
Above answer was peer-reviewed by : Dr. Yogesh D

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