Blepharospasm and Hemi-facial spasm
Benign essential blepharospasm is a debilitating and cosmetically embarrassing condition where orbicularis oculi, the eye closing muscle, goes into episodic spasms. It usually affects both sides and is much more common in women. The spasms can extend down into the facial muscles of the mouth in which case it is labelled as orofacial dyskinesia or Meige’s syndrome. The spasms settle during sleep. The problem is thought to originate in the base of the brain.
Other causes include brainstem strokes, Parkinson’s, MS and Huntingdon’s chorea.
In children a similar condition may occur as part of a tic. It may occur in Tourette’s syndrome.
Hemi facial spasm affects the entire side of the face, and does not disappear during sleep. It is one-sided and much more likely to have an underlying cause such as a dilated vessel in the brain pressing on the nerve or a cerebellopontine tumour of the brain.
This is a very benign unilateral twitching of the muscle. It may occur when tired, stressed or with caffeine consumption. It is harmless and does not need investigation or treatment.
Hemi-facial spasm needs investigation with MRI to exclude a compressive cause.
BOTOX® is a protein that can be injected around the muscle, preventing the spasms very effectively for up to six months. In severe cases the orbicularis muscle can be stripped surgically with good effect.