Question: I have had hemifacial spasm for over 15 years. My doctors have tried medication, Botox injections, and two surgeries. Are there other options?

Dr. Hibberd's Answer:

Re-review of the cause of your problem can be more easily accomplished by locating the site of irritation. Studies such MRI scanning, possibly in conjunction with an MRA and an EMG study of your face, together with some basic blood work may provide useful information to your doctors.

Most often, anticonvulsants (Tegretol, Dilantin, valproic acid, Neurontin, etc.) are the preferred agents to use with, or without, muscle relaxants (such as Valium, baclofen, clonazepam, etc.) to block the nerve excitation.

Some cases may benefit from local Botox injections to block the electrical message to your affected muscles. They usually last up to three months.

Neurosurgery for decompression has been successful, but cases need to be carefully selected as complications include decreased hearing and facial weakness (permanent), not to mention the usual operative complications depending upon where the decompression is conducted. Craniotomies are no light surgery!

Sometimes selective laser procedures are used for intractable pain, but remember the laser is an electronic knife. It is very useful for difficult-to-reach areas, but not so good if adjacent areas might be damaged that may produce a greater disability than what you presently deal with.