Life altering health issues! In 2006 a small twitch eventually turned my whole life upside down. As the condition progressed I found myself isolating myself from social events due to poor self image. It didn’t bother me to go to work because I worked in surgery and my patients were honed in on their own healthcare issues and really didn’t give much notice to my condition. Well except for one nasty ill tempered patient who was upset because I did not smile at him. Little did he know my face had been injected with a large amount of Botox and my face was frozen on one side and I was unable to smile.
Kenneth Casey, M.D. Department of Neurological Surgery Wayne State University Detroit, Michigan
This is a condition in which there is involuntary twitching of muscles that are innervated by the seventh cranial nerve. The condition has two forms: typical and atypical. In the typical case, the twitching starts around the eye, usually the lower lid. As time progresses, the twitching spreads to include the whole lid, then the cheekbone area, then the lower jaw. As the progress is usually inexorable, the muscles in the neck become involved. In the atypical cases, the twitching starts in the lower face and progresses to involve the remainder of the facial muscles. It can sometimes be triggered by volitional contraction of certain facial muscles, especially puckering the lips or forcefully closing the eyes. Stressful situations or fatigue may also worsen the spasms. Estimates suggest that one in ten thousand people have hemifacial spasm.
A common feature is the development of a twitch that does not stop: tonus. In the eye area, this causes the eye to close, a prolonged wink, which the sufferer cannot usually oppose. The tonus phenomena lasts a few seconds, but can be prolonged.
As the twitching increases, and especially after the onset of tonus, there is often some underlying muscle weakness seen during periods of muscle relaxation.
The twitching is usually described as a sense of the lower lid moving, but may not be visible at all times. The patient usually experiences a feeling the muscles are always moving, to some degree.
The differential diagnosis of Hemifacial spasm helps to demonstrate how to make a secure diagnosis.
Hemifacial spasm is generally recognized as resulting from compression of the seventh cranial nerve as it exits the brainstem. The compression can be from a blood vessel (common) or a tumor (rare). This can result in the common hyperactive (spasm) form or the less appreciated hypoactive (palsy) form of nerve compression.
The diagnosis of hemifacial spasm is made by taking a history and doing a complete office exam. The facial electromyography study offers insight to phenomena labeled “lateral spread” This test identifies excessive activity in the nerves of the face, related to the hyperactivity found in the controlling cells in the brainstem (nucleus). It can be useful postoperatively, to help decide if the nerve has been well decompressed. A Magnetic Resonance Imaging (MRI) study is useful to delineate the anatomy in this disorder, but does not make the diagnosis. The rare occurrence of a tumor compressing the nerve does make the radiologic study useful.
There are no medicines that can effectively control the spasm. Several classes of medicines (anti-spasmodics, anticonvulasants) will reduce some of the symptoms, for a time.
Botulinum toxin has been advocated for symptom control. This agent is a synthetic form of a biotoxin. It affects the muscle nerve connections, making it difficult for the nerve to excite the muscle into activity. It usually lasts for 11 weeks median effect, and has been associated with some waning effects with prolonged use. There are two forms of the agent at present. Neither is superior to the other for this application.
Microvascular decompression (MVD) was described by Dr. Peter Jannetta. This operation is directed to the cause of the problem, vascular compression. The goal is to move the vessel (artery or vein) away from the vulnerable site on the nerve and provide a pad to prevent future compression. Complications can include infection 1%, brain fluid leak 3%, facial weakness 1.4%, hearing loss 0.86%, and stroke <0.5%. Successful spasm relief ranges from 79% to 95%. The difference in the groups relates in part to patients in the former group who had undergone a previous procedure. Recovery from the procedure usually takes six weeks. Patients are usually out of the hospital on the second or third postoperative day. They are fatigued, however. The spasm can persist in 44% of patients, taking up to 18 months for complete resolution. 90% of patients are spasm free by 12 weeks after surgery.
Well I had finally reached my intolerance level and decided to have the Micro Vascular Decompression brain surgery. I was scared, excited, relieved, and so ready to get on with my life spasm free. Had The surgery on Wednesday (2013), was miserable with headaches all day Thursday, was released on Friday, and drove myself to Wal-Mart on Sunday. Because of the lack of muscle tone on the one side of my face, they thought I would have to go through physical therapy. By the 3rd day my face went back to normal so no physical therapy was necessary. I am BLESSED, and very THANKFUL that my surgery went well with no complications. It is going into my 3rd year now and I am happy to say that I am spasm free thanks to Dr. Casey’s education and surgical skills. He gave me back my life.
What I have learned through this process is just how precious life is. Oh, I knew just how fragile life was – learned that by working in surgery for many, many years and the tragic cases I was involved in. It is easy to be a bystander watching it happen to someone else’s life, however to live it is another story. It has changed my perspective for sure! I don’t do drama, I don’t do whiners, I don’t do self-pity! I do self-love, self affirmations, gratitude journaling, and live each day with the intention of enjoying what I have today. Life is a BEAUTIFUL thing and Cronehood is a privilege that some are denied.