Hemifacial Spasm

Hemifacial spasms are unilateral involuntary contractions involving muscles of facial expression. Incidence is less than 1 in 100,000 with prevalence rates higher in women than men, and an average age of onset in the fourth or fifth decade. The spasms last but a few minutes and come in bursts, often triggered by facial behaviors such as eating, speaking, or changes in head position. Typically, the first muscles involved are in the periorbital region, preceded by facial weakness, and within months spreading to ipsilateral facial muscles. These twitches continue in sleep. Blink reflexes are expressed normally. Hemifacial spasms occur when the facial nerve is compressed at the root entry zone, usually by the anterior or posterior inferior cerebellar or vertebral artery. Treatment of choice is botulinum toxin injections, but clonazepam is also prescribed (Sathornsumetee and Stacy in press). [Video Segment 29]

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