Facial spasms

The muscles of facial expression and the eyelid are normally under our voluntary control. Facial spasm is a condition in which these muscles function abnormally and are no longer under the direct control of the brain. It can affect the entire face, or just the area around the eyes.
Four distinct forms of facial spasm are known:

  Benign Essential Blepharospasm – In this condition there is involuntary contraction of muscles around both eyes. It may result into rapid fluttering of eyelids, difficulty in opening eyelids, or forced contraction of the lids & brows.

  Meige syndrome – When the contraction also involves all facial muscles and neck muscles, it’s called Meige syndrome.

  Hemifacial spasm – It is uncontrolled contraction of the muscles on one side of face, usually including the eyelids.

  Myokimia - It is a more localized form of spasm, that typically involves a single eyelid or periocular area.

Treatment of blepharospasm & hemifacial spasm with medications is difficult. The benefits are variable and short lasting with often undesirable side effects. The most common and effective treatment of these conditions are with Botulinum Toxin injections. Botulinum toxin A is approved by FDA for treatment of these disorders. The toxin is injected into the muscles at several sites around the eyelids, brows and face to prevent unwanted contractions.
Injection procedure is performed as an out patient procedure. Application of anesthetic cream an hour before the procedure makes it almost painless. The effect takes 7-10 days to come, and can last for 3-4 months.

Botulinum toxin controls the spasm, and does not treat it. Therefore, repeated injections are required for continued effect. This treatment is safe and effective. Side effects are uncommon and transient, and may include droopy eyelids and double vision.
Some patients may be non-responsive to Botulinum toxin injections, and would need surgical procedure to control spasm.

Concerned Doctors in CLGEI
Dr. Debarati saha
, M.B.B.S., M.S. ,FLVPEI (Hyderabad)