Hemifacial spasm and other hemifacial abnormal movements: Clinical aspects

Summary

This chapter describes clinical aspects of Hemifacial spasm (HFS), based on a review of 72 patients with HFS included in a study of subcutaneous botulinum toxin treatment. The semeiology of these patients with HFS appeared to be stereotypical and consisted of a mixture of uncontrollable twitching and/or sustained contractions limited to the facial territory. Of the 72 patients (age range: 26–83 years), 64% were female. HFS occurred predominantly on the left side (52% against 45% on the right side and 3% on the both sides of the face) without provocative circumstances in most of the cases. Three groups have been characterized according to the extent and the intensity of spasm: mild (8%), moderate (80%) and severe (12%). The ‘severe’ group appeared to be accompanied by a long evolution of HFS, slight facial weakness and conjunctival irritation. Alternative bilateral spasm, “tic convulsif”, familial forms and secondary spasms are described in the second part of this manuscript and presented as particular aspects of HFS. Finally, and in order to better understand clinical aspects of HFS, other hemifacial abnormal movement disorders are also reported and discussed as differential diagnoses of HFS.