How can I stop uncontrollable twitching on my face?

It is a fairly common condition that is normally reported by people after the fourth decade of life.

Q: I am a 69-year-old woman. For the past two years, the left side of my face has been twitching very frequently.

The twitching starts from the corner of my mouth all the way to my left eye. Sometimes, I feel I cannot open my eye properly.

The skin affected by the twitching feels tight. The twitching happens in the morning when I get up, and when I am eating, drinking, reading and even when I am writing this e-mail message.

It also occurs in the middle of the night and it wakes me up.

I cannot talk to friends and family without them noticing it and asking me why it is happening. It is affecting my social life and making me miserable when it happens, which is more often than not.

I wonder if the twitching might be related to my hearing implant. I had the hearing implant inserted in my left middle ear five years ago, after I experienced some hearing loss.

Last year, I had a scan to see if the implant had shifted. Apparently, it was still sitting in the correct position.

I do not want to go through the rest of my life with this condition. Please help.

A: Twitching that occurs on only one side of the face, with no other neurological abnormalities, is known as hemifacial spasm.

It is a fairly common condition that is normally reported by people after the fourth decade of life.

The two nerves that supply sensation to the muscles of a person's face - one on each side of the face - are called the facial nerves.

Each facial nerve originates from the back part of the brain and traverses along the floor of the skull before emerging near the ear and entering the facial region.

Along the floor of the skull, each facial nerve often runs adjacent to blood vessels.

One of these vessels may be situated near enough to the nerve to cause some irritation to it, and this manifests as uncontrolled twitching of the muscles that it supplies sensation to.

Apart from blood vessels, other structures may sometimes be the cause of hemifacial spasm.

The frequency of the twitching can range from a few flickers on and off to nearly continuous twitching throughout the day.

The twitching can be aggravated by bright lights, lack of sleep, emotional stress, touch and various other external factors.

However, hemifacial spasm is not a life-threatening condition.

There are generally three different modes of treatment.

Oral medication may help alleviate some of the twitching.

But the use of such medication is often limited by its sedating side effects.

The efficacy of oral medication is therefore quite low.

Botulinum toxin injections into the affected muscles usually give quite good results. The toxin - which is commonly known by one of the trade names, Botox - relaxes the muscles.

The aim of the injections is to significantly reduce the twitching, not to totally abolish them.

This is because to do so, high doses of botulinum toxin will be required, but that will cause undue muscle paralysis.

The injections take a few days to exert their effect, which can last up to three months.

Botulinum toxin injections do not, however, cure the condition.

The last option, which is rarely required, is to surgically separate the facial nerve from the blood vessel that is irritating it.

You can see a neurologist to get your condition assessed.

In the assessment, the doctor will check if you suffer from hemifacial spasm and decide if a magnetic resonance imaging scan of the brain is needed to confirm the diagnosis.

Very often, no scans are needed.

If you are diagnosed with hemifacial spasm, your doctor would be able to help you decide which treatment option is best suited for you.

Dr June Tan
Senior consultant at the division of neurology at National University Hospital


Get a copy of Mind Your Body, The Straits Times or go to straitstimes.com for more stories.

SERVICES