From the Research
Botulinum toxin injections are the first-line treatment for hemifacial spasm, as they provide significant improvement in symptoms with minimal side effects, as shown in a recent study 1. The treatment typically involves administering onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), or incobotulinumtoxinA (Xeomin) directly into the affected facial muscles every 3-4 months.
- The typical starting dose ranges from 10-30 units of onabotulinumtoxinA, with adjustments made based on individual response.
- The injections work by blocking the release of acetylcholine at the neuromuscular junction, preventing muscle contractions that cause the spasms.
- Treatment sessions take about 10-15 minutes, with effects beginning within 2-3 days and peak effect at 1-2 weeks.
- Side effects may include temporary weakness, drooping of the eyelid or corner of the mouth, dry eye, or bruising at injection sites. While botulinum toxin provides symptomatic relief, it does not address the underlying cause, which is typically vascular compression of the facial nerve.
- For patients who don't respond to botulinum toxin or prefer surgical intervention, microvascular decompression surgery may be considered as a more definitive treatment option, as supported by studies 2, 3, 4, 5. However, the most recent and highest quality study 1 suggests that botulinum toxin injections are the preferred initial treatment due to their efficacy and safety profile.