Mr Prakash Girnar

What is Hemi-facial spasm?

What are the symptoms of this disease? How do we diagnose this, what are the available treatments, and how to choose the right one? These are some of the most frequently asked questions in my clinic. Hemifacial spasm is also called ‘winking disease’ or facial twitching disease. In this disease patients suffer from pulling(contraction) of the facial muscles on one side of the face, which they are not able to control. This usually results in winking of the eye on that side. This is very embarrassing and can lead to socio-psychological problems. Normally these symptoms start when the person is mentally stressed or under pressure….like giving exams or an interview or starting a conversation. As the disease progresses and frequency of spasms rise, it no longer holds just a cosmetic/ social significance…. The patient is occasionally not able to speak because of the twitches!!

What causes Facial twitching?

The Facial nerve controls the movements of our facial muscles, as well as our facial expressions…. if the facial nerve gets irritated due to some reason or is compressed either continuously or in a pulsatile manner, then it is fires repeatedly- sending signals to the muscles to contract. Initially, the spasms are less intense, more focused around the eye muscles and are less frequent; as the compression on the facial nerve by the vessel progresses, the nerves ‘weaken’ because of constant pulsations. All nerves have individual fibres like wires in an electrical cable. These nerve fibres are very close to each other and, like in an electrical cable individual wires are separated from each other by insulation. The equivalent of insulation in nerves is called myelin sheath. In Hemifacial spasm, when there is compression by the blood vessel the myelin is damaged and the nerve fibres short circuit because of lack of insulation…it’s like ‘cross-talk’. The longer the compression, the greater is the damage(demyelination). The symptoms worsen, and the recovery becomes more unpredictable.

How is Hemifacial spasm diagnosed?

Facial nerve is specially studied in very small slices of MRI to the minutest detail, and to rule out tumours in that area.

Can hemifacial spasm be cured?

It is not widely known, among public and even among doctors that patients with this disorder can be offered surgery and that they can be cured…so people suffer and bear this trauma for many years.

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