Facial twitching (hemifacial spasm) treatment

It is the involuntary, involuntary, spontaneous contractions of the muscles in the eye, mouth, and sometimes the neck region. Facial twitches typically begin around the eye and then spread to other facial muscles around the mouth. While the spectacles are very infrequent in the beginning, they come more frequently later on. While watching increases during fatigue, stress, anxiety and excitement, it decreases during rest and sleep.

General features of facial twitches: This disease is seen in 14-15 people in 100 000 women, 7-8 people out of 100 000 men. Although they are most commonly seen at the age of 40-60, it increases up to 40 per 100 000 people at the age of 70. Women are affected twice as often as men. Familial transmission has been reported in 1-2% of all facial twitches.

Clinical features of facial twitches: Facial twitches are a chronic disease with intermittent movements, and patients talk about painless, repetitive, and temporary tremors in their facial muscles. There are intermittent irregular contractions in the muscles on one side of the face, and these contractions begin in the muscles around the eyes on one side, and then they are seen in the muscles around the mouth and sometimes even in the neck muscles. These involuntary movements cannot be stopped by the patient, they increase especially during excitement, anxiety, speaking, chewing and effort, sleep
Cause and formation of facial twitches: Facial twitches are classified in two groups:

1: Primary facial twitching: This type of facial twitching is the general feature of the absence of facial nerve palsy on the same side, the absence of lesions other than arterial pressure, and the chronic course. In such patients, an artery causes twitching by creating pressure on the facial nerve, preventing physiological transmission in the nerve.

2: Secondary facial twitching, other underlying diseases are usually responsible for facial twitching; (Head trauma, brain tumors, cerebrovascular diseases, multiple sclerosis) Diagnosis of facial twitches: A comprehensive neurological examination: seeing facial muscle movements in facial twitches is very important in the diagnosis of this disease. The patient’s speech or excitement makes the twitches, which are the image of this disease, visible. Neurological examination is usually normal in primary facial twitches. On the other hand, in sochondral twitches, it may cause neurological findings of the disease that causes compression of the cerebellum or other adjacent brainstem nerves. Brain Magnetic Resonance (MR) technique, one of the imaging methods in Diagnosis, reveals the cause of both primary and secondary facial twitches. Here, it is important to make a research and examination of the facial nerve, especially when using this technique.

3: EMG (electromyelography) technique, which is one of the physiological conduction studies of the facial nerve, is important to distinguish some diseases that mimic this facial nerve.
Differential diagnosis of facial twitches:

1: Facial tic: Similar involuntary movements in other muscles of the body other than the facial muscles. Its difference from hemifacial spasm is partial suppression of movements.

2: Blepharospasm: It is distinguished from hemifacial spasm by the involvement of bilateral symmetrical and synchronous eye muscles.

3: Oromandibular dystonia: There are repetitive and continuous contractions in the lower face, jaw, tongue, throat and mouth muscles, and eye muscles are not involved.

4: Facial myokymia: It is continuous and wave-like involuntary contractions of the facial muscles.

5: Tardive dysnesia: Stereotypical movements of the face, neck and arms. Rotation in the trunk and wrinkling of the face are typical.

6: Focal epileptic seizures: Focal epileptic seizures affecting one half of the face are mixed with facial twitches.

7: Psychogenic: They do not fall asleep at night.

Treatment of facial twitches: Medical treatment: Among the drugs used here: carbomezapine, anticholinergics, baclofen, haloperidol, gabapentin, and other drugs are aimed at sedation. Perhaps these drugs can only be considered in mild cases and in patients who cannot be treated with surgical techniques. Apart from this, it should not be considered as a treatment option for facial twitches. The effect of this treatment is limited.

Botulinium toxin injection: By inhibiting the acetylcholine synapse, it causes loss of neuronal activity in the target organ. It was used for the first time in 1985 in facial twitches, the success rate reaches 75-90% according to different reports, the duration of action is limited to a few months, and it must be repeated. It has complications such as dry eye, paralysis of the eyelid and facial muscles, double vision, excessive tear secretion. The most common side effect is drooping of the eyelid at a rate of 20%, the most important disadvantages of this treatment are its high cost and repetitive treatment.
injection is needed.

Surgical treatment: This treatment option is the radical and gold standard treatment method in this disease, surgical microvascular decompression (MVD). There are two main indications for this surgical treatment option.

1: When repeated botox injections or medical treatment options are applied,

2: When all kinds of drug treatment options are applied,

Surgical treatment is recommended for those whose facial twitches affect the patient’s living conditions, in order to achieve a permanent and perfect cosmetic result. Today, microsurgical decompression surgeries performed in well-equipped hospitals in experienced hands have a very low complication rate.
has. As a result of facial twitch surgery, aesthetic problems and the cosmetic result expected by the patients are obtained.

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