by Dr. Michael Horowitz

Hemifacial spasms (HFS) causes muscles of one side of the face and often the neck to contract uncontrollably. What can cause hemifacial spasm? No one knows exactly what causes Hemifacial spams, but we do know that when blood vessels resting against the facial nerve at the point where it arises from the brainstem beat (pulse) against the nerve with each heartbeat, the nerve reacts and causes the facial muscles on one side of the face to contract uncontrollably.


HFS is treated in two ways. The first way is to inject Botox into the muscles of the face to reduce the muscles’ ability to contract uncontrollably, paralyzing the muscles. This is a temporary treatment that must be repeated every few months. Repeated use of Botox may ultimately permanently weaken the muscles resulting in a permanent facial droop. Repeated use of the drug also makes it necessary overtime to increase the dose of drug used with each treatment.


The second way to treat Hemifacial spams is by surgically moving the blood vessels that are beating on the nerve as the nerve exits the brainstem and placing a small Teflon pillow between the nerve and the arteries and veins.  This procedure is called a microvascular decompression (MVD). If you undergo microvascular decompression treatment there is a greater than 85% chance of cure.  Your surgeon can discuss each of these treatment options with you and recommend the best treatment for your case.

Dr. Michael Horowitz, Neurological Surgeon