58-Year-Old Woman Diagnosed with Hemifacial Spasm Finds Relief Through Targeted Medical Treatment

Disclaimer: This article is intended solely for educational and informational purposes. To protect patient privacy, certain personal details have been altered or generalized.

Overview: From Diagnosis to Recovery

A 58-year-old female patient began experiencing involuntary twitching around the left corner of her mouth two months prior to seeking medical attention. The spasms occurred more frequently during daytime activities, especially when making exaggerated facial expressions, and reportedly ceased during sleep. She had a history of facial nerve inflammation one year earlier, which left mild residual asymmetry in her smile. After thorough evaluation—including brain imaging and neurophysiological tests—she was diagnosed with hemifacial spasm. Treatment with a combination of nerve-supportive and antispasmodic medications led to noticeable improvement in her symptoms within a week.

Patient Profile at a Glance

Gender: FemaleAge: 58 years oldDiagnosis: Hemifacial SpasmHospital: Second Affiliated Hospital of Harbin Medical UniversityDate of Admission: January 2022Treatment Plan: Combination drug therapy (Mecobalamin injection + Xuesaitong injection + Carbamazepine tablets + Vitamin B1 + Estazolam)Duration of Hospital Stay: 8 daysTreatment Outcome: Significant reduction in facial twitching and associated discomfort

Initial Consultation: Recognizing the Symptoms

The patient visited our neurology department in January 2022 after enduring persistent left-sided facial twitching for two months. She described how the muscle contractions worsened during emotional expressions or stress but disappeared while sleeping. In addition to the visible spasms, she reported tightness around the mouth, intermittent facial pain, and headaches that intensified after sweating on her forehead. These headaches lasted about an hour and were accompanied by nausea and occasional vomiting—though no loss of sensation or facial numbness was noted.

Her medical history included a previous episode of facial neuritis approximately one year ago. While she maintained normal eating habits and bowel/bladder function, she struggled with chronic sleep disturbances. A non-contrast CT scan of the head revealed multiple lacunar infarcts bilaterally, prompting further investigation. Given her clinical presentation and imaging results, hemifacial spasm emerged as the most likely diagnosis, and she was admitted for comprehensive management.

Diagnostic Workup and Treatment Strategy

Upon admission, physical examination showed clear consciousness, stable vital signs (temperature: 36.6°C, blood pressure: 110/70 mmHg, heart rate: 75 bpm, respiratory rate: 17 breaths/min), and signs consistent with left-sided peripheral facial palsy. Notably, there was no auditory hypersensitivity.

Advanced imaging via MRI confirmed the presence of multiple small-area strokes (lacunar infarcts) and evidence of cerebral vascular stenosis. Electromyography (EMG) of the orbicularis oris muscle and electroencephalogram (EEG) did not show epileptiform activity or neuromuscular junction abnormalities, supporting the diagnosis of focal facial dystonia rather than seizure-related movement disorders.

Personalized Treatment Approach

After discussing the diagnosis and treatment options with the patient and her family, we initiated a multifaceted pharmacological regimen designed to address both symptom control and underlying nerve health:

• Mecobalamin Injection: To support nerve regeneration and repair.
• Xuesaitong Injection: A traditional Chinese medicine extract used to improve microcirculation in the brain.
• Carbamazepine Tablets: An anticonvulsant effective in reducing abnormal nerve firing responsible for muscle spasms.
• Vitamin B1 (Thiamine): Essential for maintaining healthy nervous system function.
• Estazolam: A short-acting benzodiazepine prescribed to improve sleep quality and reduce anxiety-induced exacerbations.

The patient responded positively to this integrative approach, expressing willingness to adhere strictly to the treatment plan.

Observed Clinical Improvements

Following eight days of inpatient care, the patient experienced a marked decrease in the frequency and intensity of facial twitching. The previously reported sensations of tightness around the mouth and chronic headaches significantly subsided. Nausea and vomiting resolved completely, and subjective reports indicated improved rest and mood.

However, due to the prolonged duration of prior facial nerve damage, full correction of facial asymmetry remained limited. Based on her progress, the care team determined that outpatient rehabilitation would be beneficial. We recommended continuing with acupuncture therapy and facial neuromuscular retraining exercises to further enhance motor recovery and prevent relapse.

Post-Discharge Guidance for Long-Term Wellness

We are encouraged by the patient's positive response to treatment. As she transitions to home care, ongoing lifestyle modifications play a crucial role in sustaining improvement and preventing recurrence.

Dietary Recommendations

A balanced diet rich in antioxidants and anti-inflammatory nutrients is essential. Patients are advised to consume plenty of fresh fruits, leafy greens, whole grains, legumes, and fatty fish such as salmon—foods known to support neurological health. It's equally important to avoid spicy, fried, or highly processed foods that may trigger inflammation or vascular stress.

Lifestyle and Environmental Precautions

Facial nerves are sensitive to temperature changes and drafts. We strongly recommend avoiding direct exposure to air conditioning vents, cold winds, and icy water—especially when washing the face or hair. During winter months, wearing scarves or face masks can provide added protection. When traveling by car, it's best not to open windows on the affected side to minimize air pressure fluctuations near the face.

Mental and Physical Wellbeing

Emotional well-being directly impacts neurological conditions. Stress reduction techniques such as mindfulness, gentle yoga, or breathing exercises can help maintain nervous system balance. Applying warm compresses with a damp towel to the affected area may also relieve muscle tension. Finally, ensuring 7–8 hours of quality sleep per night and engaging in regular low-impact physical activity supports overall recovery and resilience.

Clinical Insights: Understanding Hemifacial Spasm

Hemifacial spasm is a neurological condition characterized by involuntary, irregular contractions of muscles innervated by the facial nerve—typically starting around the eye and progressing to the mouth. Although painless, these spasms can significantly affect daily life and self-esteem.

In many cases, including this one, the root cause appears linked to prior facial nerve injury—in this instance, a past episode of facial neuritis that likely led to demyelination and vascular compression at the nerve root entry zone. This creates hyperexcitability in the nerve circuitry, resulting in uncontrolled muscle firing.

Pharmacological interventions like carbamazepine remain first-line treatments, often combined with neurotrophic agents such as vitamin B1 and mecobalamin to promote healing. For patients who do not respond adequately to medication, surgical options exist, including microvascular decompression (MVD)—a procedure that relieves pressure on the facial nerve by repositioning offending blood vessels—and selective neurolysis in severe cases.

Early diagnosis and multidisciplinary care greatly improve outcomes. With proper treatment, most patients experience meaningful relief and can return to normal routines with confidence.