Hemifacial spams can be treated with oral medication such as carbamazepine, baclofen and gabapentin which all work by decreasing the nerve hyperactivity which causes hemifacial spasm. Unfortunately, oral medications are only partially effective in treating the symptoms and can be limited by side effects of dizziness and sedation.
Botulinum toxin (Botox) is the treatment of choice. In the office, the neurologist will inject the affected muscle with Botox and within 7-10 days, most patients experience marked relief. Side effects include facial muscle weakness and double vision and can be minimized when performed by an experienced neurologist. Injections must be repeated every three months.
In patients who have symptoms which do not respond to oral medications or Botox, surgical options (surgical nerve decompression) are available which relieve the pressure on the affected nerve.
More Answers from Darshan Shah, MD