Relevant conflicts of interest/financial disclosures: Nothing to report.
Article first published online: 5 APR 2011
Copyright © 2011 Movement Disorder Society
Volume 26, Issue 9, pages 1582–1592, 1 August 2011
How to Cite
Yaltho, T. C. and Jankovic, J. (2011), The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms. Mov. Disord., 26: 1582–1592. doi: 10.1002/mds.23692
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 9 AUG 2011
- Article first published online: 5 APR 2011
- Manuscript Accepted: 3 FEB 2011
- Manuscript Revised: 29 JAN 2011
- Manuscript Received: 18 AUG 2010
- hemifacial spasm;
- hemimasticatory spasm;
Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n = 23, 11%), facial nerve injury (n = 13, 6%), demyelination (n = 2), and brain vascular insults (n = 2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features. © 2011 Movement Disorder Society