Times of India
21 April 2010
By Umesh Isalkar
Pune, India

It was impossible for 25–yearold Mitali, a marketing professional, to attend the office for the fear of being ridiculed. She had become a recluse as she dreaded the idea of attending parties or public gatherings.

It started with quivering of eyelashes or muscles around the eye, slowly developing into embarrassing expressions which can be mistaken as winking.

Hemifacial spasms, doctors say, can affect people of any age group and may result in the affected disassociating himself from the society fearing embarassment. But the medical science has an answer to the problem as more and more youngsters suffering from the malaise opt for corrective surgery.

“I had gradually become an outcast as the nerve disorder badly affected my self–confidence,” said Mitali, recounting her story before she came for suture removal at Deenanath Mangeshkar Hospital (DMH) on Tuesday. About ten days back, she had undergone a microscopic surgery aided by an endoscope for her hemifacial spasms.

After the surgery, Mitali’s facial spasms (repeated twitching of the facial muscles) have vanished and she is a now new person exuding confidence.

“It started with quivering of eyelashes or muscles around the eye and gradually spread to entire half of the face resulting in extremely embarrassing facial expressions which can be mistaken for winking during social interactions,” said Mitali.

Elaborating on this condition, neurosurgeon Jaydeo Panchwagh of DMH said,“Hemifacial spasms is a condition which affects young, middle aged and elderly and is such an embarrassing situation that it literally kills one’s social life, making him a social recluse. I have been performing two to three surgeries per week of microvascular decompression either for trigeminal neuralgia (severe facial pain) or hemifacial spasms.”

Sharing the view, neurologist Rahul Kulkarni said,“I get five to six patients with facial spasms every week. It is not an age specific condition.”

In hemifacial spasms, one half of the face or a part of it twitches repeatedly, uncontrollably and involuntarily. This can start any time but is especially pronounced in tense situations and social interactions, added Kulkarni.

Unfortunately, there is no definite medical treatment for this embarrassing malady, said neurologist Rajas Deshpande of Sancheti Hospital said.“However there are drugs which reduce the spasms and in many patients even stop the spasms at higher doses. However, the tolerance of these medicines especially in the elderly is a big problem. Botox (botulinum) is very costly, painful and the effect of it lasts for three to four months only. I see around three to four patients every month. The condition is at its mild stage at younger age and becomes severe as well as embarrassing as age advances. That’s why younger people are immediately seeking treatment as there is much awareness among them now.”

Micro–vascular decompression is the surgery which spells literally a great relief in these patient’s life, says Panchawagh.

“Very few people know about this surgery though it is well established and proven in efficacy all over the world for over twenty years now. After performing over 50 such surgeries I can say that it should be advised confidently in rather early stages before one’s personality is affected,” says Panchwagh. It is true that it needs high degree of technical skill and an experienced hand. Results may suffer in hands of surgeons who perform this surgery occasionally, he added.

In this surgery, the area where the facial nerve is getting compressed is exposed with the help of neurosurgical microscope. Tiny circular mirrors or small endoscopes are then used to inspect this critical area further. The compressing blood vessels are then carefully and gently separated by microsurgical dissection and a small piece of Teflon sponge is inserted between the two structures (the facial nerve and the compressing vessel) to separate them. Thus, once the facial nerve is decompressed, it stops firing and consequently the spasms stop, added Panchwagh.

What Causes Spasms?
The question was unanswered for a long time. It was only towards the end of the last century that the real cause was discovered. Our facial muscles move on command from brain and this command is transmitted to them via the“facial nerve”. In hemifacial spasms, this nerve is compressed by one or more arteries near the lowermost part of the brain called the“brain stem”. This nerve is irritated by the compressing blood vessels and starts firing indiscriminately. In short, this nerve which is supposed to fire only when commanded by the brain to carry out facial movements while talking, laughing, crying, or any other facial activity. In hemifacial spasms the nerve on one side fires without command, repeatedly in quick successions to cause facial spasms or twitches only on one side of the face.
(Source: Neurosurgery Department, Deenanath Mangeshkar Hospital, Pune)