title: Hemifacial spasm: conservative and surgical treatment options.
abstract: BACKGROUND
  Hemifacial spasm is a neuromuscular movement disorder characterized by brief or persistent involuntary contractions of the muscles innervated by the facial nerve. Its prevalence has been estimated at 11 cases per 100 000 individuals. Among the patients who were operated on by our team, the mean interval from diagnosis to surgery was 8.2 years, and more than half of them learned of the possibility of surgical treatment only through a personal search for information on the condition. These facts motivated us to write this article to raise the awareness of hemifacial spasm and its neurosurgical treatment among physicians who will encounter it.
  
  
  METHODS
  This review article is based on a selective literature search and on our own clinical experience.
  
  
  RESULTS
  Hemifacial spasm is usually caused by an artery compressing the facial nerve at the root exit zone of the brainstem. 85-95% of patients obtain moderate or marked relief from local injections of botulinum toxin (BTX), which must be repeated every 3 to 4 months. Alternatively, microvascular decompression has a success rate of about 85%.
  
  
  CONCLUSIONS
  Local botulinum-toxin injection is a safe and well-tolerated symptomatic treatment for hemifacial spasm. In the long term, however, lasting relief can only be achieved by microvascular decompression, a microsurgical intervention with a relatively low risk and a high success rate.
authors.affiliation: University Medicine Greifswald, Department of Neurosurgery, Germany. chr.rosenstengel@uni-greifswald.de
authors.forename: Christian
authors.initials: C
authors.lastname: Rosenstengel
authors.forename: Marc
authors.initials: M
authors.lastname: Matthes
authors.forename: Jörg
authors.initials: J
authors.lastname: Baldauf
authors.forename: Steffen
authors.initials: S
authors.lastname: Fleck
authors.forename: Henry
authors.initials: H
authors.lastname: Schroeder
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005155:Facial Nerve Diseases / Q000150:complications* / Q000628:therapy*; D019569:Hemifacial Spasm / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D061145:Microvascular Decompression Surgery / Q000379:methods*; D009465:Neuromuscular Agents / Q000627:therapeutic use
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A