Facial Spasms and Paralysis


What are Facial Spasms?

Facial spasms present as twitches of the eyelids and facial muscles. They may occur on one or both sides of the face. They can be quite localized, such as only in the eyelids, or more diffuse throughout the entire face and even into the neck. Facial spasms arise due to a variety of conditions. In minor forms, such as myokymia, the eyelid may twitch temporarily due to irritants, stress, lack of sleep or caffeine. Spasms may also occur after a significant physical trauma.  Occasionally, this may be a sign of an issue with nerve pathways. The most common conditions include myokymia, benign essential blepharospasm, and hemifacial spasm. Occasionally, your surgeon may work together with either a neurologist or neuro-ophthalmologist to help determine the correct diagnosis.

Treatment Options for Facial Spasms :

The most effective treatment for spasms is botulinum toxin injections. While generally botulinum toxin, such as Botox, is thought to be predominantly for cosmetic conditions, botulinum toxin has high efficacy for spasm conditions. Botulinum toxin works on nerves to weaken the action of muscles. For cosmetics, this helps to reduce wrinkles caused be repetitive muscle contraction. For spasms, botulinum works to weaken the muscles causing eyelid or facial spasm. 

Oral medications have varying degrees of effectiveness. These options could be attempted, though they often have side effects that may reduce the tolerability of the medication. 

Surgeries are also available for spasms, though they have variable success rates, and you may still require botulinum toxin after surgery. 

What to Expect With Treatment :

Botulinum toxin injections are given in the office setting. The treatment itself takes less than five minutes to administer. The treatments are given approximately every 3 months, though treatment intervals vary by patient. Occasionally, bruising or redness may occur after your botulinum injection, though this is self-limited. The treatment starts to work at about 3 days after your treatment, with maximal effect at about 1 week after treatment.  Treatment strengths and patterns are typically adjusted at future treatments to meet your needs.