What is a Hemifacial Spasm?

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  • Written By: D. Jeffress
  • Edited By: Bronwyn Harris
  • Last Modified Date: 20 October 2019
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A hemifacial spasm is an uncontrollable contraction or twitch in the muscles on one side of a person's face. It is considered a neuromuscular disorder that can arise from facial trauma, compressed nerves, cancer, or an underlying disease such as multiple sclerosis. A hemifacial spasm typically begins in an isolated area, such as the eyelid, and spreads across one side of the face over time if it is not treated. Doctors can prescribe muscle relaxants, inject muscles with botulinum toxin, or conduct invasive surgery to relieve pressure on facial nerves. Individuals who receive treatment are usually relieved of some or all of their symptoms immediately, though many patients require ongoing treatment to suppress recurrent spasms.

Most instances of hemifacial spasms arise when blood vessels become pressed against facial nerves. This can both affect the functionality of a nerve and cause it to involuntarily contract sporadically. A hemifacial spasm can happen to anyone, though they are most common in elderly citizens and those who have suffered an injury to their face, head, or brain stem. Occasionally, a tumor can compress the facial nerve and lead to spasms. Individuals with certain neurological disorders like multiple sclerosis are also prone to twitches and tics that may or may not be limited to the face.


A hemifacial spasm generally begins in one single muscle, most often the eyelid. It can cause irregular twitching and force the eye closed unpredictably. In time, it can spread down the face, eventually affecting the muscles that control mouth movement. Many people who suffer from progressed hemifacial spasms suffer from frequent tics that significantly impair their speech and sight.

It is usually easy for a trained doctor to recognize a hemifacial spasm, though it may be more difficult to diagnose the cause. A physician may use a magnetic resonance imaging machine to check for tumors or other visible abnormalities, and an electromyogram to uncover other neurological problems. An electromyogram is a small, precision needle that is inserted into a facial muscle to record electrical activity and identify irregular spasms.

Treatment for a recurring hemifacial spasm may take the form of prescription oral medication, botulinum toxin injections, or surgery. Individuals with mild or infrequent spasms may benefit from taking muscle relaxants, though doctors caution against long-term use of these potentially addicting medications. Most individuals receive local injections of botulinum toxin to effectively paralyze muscles for a period of up to eight months. If medications and injections are ineffective, or spasms are severely debilitating, a patient may need to undergo a surgical procedure known as microvascular decompression to move blood vessels and relieve pressure on the facial nerve.


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