Hemifacial spasm

Hemifacial spasm (HFS) is a rare neuromuscular disease characterized by irregular, involuntary muscle contractions (spasms) on one side (hemi-) of the face (-facial).^[1] The facial muscles are controlled by the facial nerve (seventh cranial nerve), which originates at the brainstem and exits the skull below the ear where it separates into five main branches.

This disease takes two forms: typical and atypical. In typical form, the twitching usually starts in the lower eyelid in orbicularis oculi muscle. As time progresses, it spreads to the whole lid, then to the orbicularis oris muscle around the lips, and buccinator muscle in the cheekbone area.^[2] The reverse process of twitching occurs in atypical hemifacial spasm; twitching starts in orbicularis oris muscle around the lips, and buccinator muscle in the cheekbone area in the lower face, then progresses up to the orbicularis oculi muscle in the eyelid as time progresses.^[2] The most common form is the typical form, and atypical form is only seen in about 2–3% of patients with hemifacial spasm.^[3] The incidence of hemifacial spasm is approximately 0.8 per 100,000 persons.^[4]

This disorder occurs in both men and women, although it affects middle-aged or elderly women more frequently.^[5] Hemifacial spasm is much more common in some Asian populations.^[1] It may be caused by a facial nerve injury, compression by a blood vessel, a tumor, or it may have no apparent cause. Individuals with spasm on both sides of the face are very rare.