How do you properly chart hemifacial spasm?

From the Guidelines

To properly chart hemifacial spasm, utilize the House-Brackmann facial nerve grading system, as outlined in the 2013 clinical practice guideline for Bell's palsy 1, which provides a standardized approach to assess and document the severity of facial dysfunction, including hemifacial spasm.

Key Components of Charting Hemifacial Spasm

• Document the specific facial muscles involved, frequency, duration, and severity of spasms, along with any triggers or alleviating factors.
• Note the affected side of the face and describe the pattern of muscle contractions, typically starting around the eye (orbicularis oculi) and progressing downward to involve other facial muscles.
• Record the patient's subjective experience, including pain, functional limitations, and psychosocial impact.
• Document objective findings from the examination, including visible muscle contractions, any associated findings like synkinesis, and results of neurological testing.
• Include information about previous treatments and their effectiveness, such as botulinum toxin injections, oral medications, or surgical interventions like microvascular decompression.

Utilizing the House-Brackmann Grading System

• Grade 1: Normal facial function
• Grade 2: Mild dysfunction with slight weakness noticeable only on close inspection
• Grade 3: Moderate dysfunction with obvious but not disfiguring difference between the two sides
• Grade 4: Moderately severe dysfunction with obvious weakness and/or disfiguring asymmetry
• Grade 5: Severe dysfunction with only barely perceptible motion
• Grade 6: Total paralysis with loss of tone and no motion

Imaging and Diagnostic Considerations

• For patients with clinical features of hemifacial spasm, 3-D heavily T2-weighted MRI sequences and MRA can be useful for characterizing the anatomy of vascular loops potentially compressing the facial nerve, as supported by the 2022 update on ACR Appropriateness Criteria for cranial neuropathy 1.
• High-resolution thin-cut contrast-enhanced MRI is especially useful for evaluating perineural spread of a tumor and for excluding other causes of facial nerve palsy.

Ongoing Management and Follow-Up

• Follow-up documentation should track changes in symptoms over time, treatment responses, and any complications.
• This comprehensive documentation is essential for monitoring disease progression, evaluating treatment efficacy, and ensuring appropriate ongoing management of hemifacial spasm.

From the Research

Charting Hemifacial Spasm

To properly chart hemifacial spasm, consider the following key points:

• Definition and Characteristics: Hemifacial spasm is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles, typically beginning around the eye 2.
• Diagnosis: Diagnosis is based purely on clinical observation, with differential diagnosis relying on cranial MRI to demonstrate pathological contact between nerves and vessels and exclude alternative causation 3.
• Treatment Options: Treatment options include medical treatment, botulinum toxin injections, and microvascular decompression of the nerve 4, 3, 5.
• Microvascular Decompression: Microvascular decompression is considered the treatment of choice due to its high success rate and minimal invasiveness, with long-term results showing excellent outcomes in 81.82% of patients 4, 6.
• Botulinum Toxin Injections: Botulinum toxin injections are an effective alternative, with patients responding well to symptomatic treatment without neurovascular decompression 2.
• Medical Treatment: Medical treatment, including gabapentin, can be effective in reducing spasms, but may have limitations due to side effects or low efficacy 5.

Key Considerations for Charting

When charting hemifacial spasm, consider the following:

• Patient History: Document the patient's medical history, including the onset and progression of symptoms.
• Clinical Observations: Record clinical observations, including the frequency, duration, and severity of spasms.
• Treatment Outcomes: Track treatment outcomes, including response to medical treatment, botulinum toxin injections, and microvascular decompression.
• Complications: Monitor for potential complications, such as peripheral facial paralysis, hypoacusis, and deafness, particularly after microvascular decompression 6.