Will Botulinum Toxin Injections (Botox) Help Me?

Eye and facial twitching is improved in more than 90 percent of patients receiving Botox treatment.

Treatable Symptoms

• Eye twitching and eye closing interferes with reading, driving and other day-to-day activities.
• Facial twitching occurs in synchrony with the eye twitching, and may cause embarrassment, facial discomfort and headaches.

Treatment Method

Botulinum toxin is injected specifically into the overactive muscles causing the foot cramps, eye twitching, or salivary glands for drooling. The effect comes on gradually over several days with the peak effect in approximately 2 weeks. The benefit lasts for about 3 months. As a result, injections are repeated about every 3 months in order to maintain ongoing benefit.

Prognosis When Untreated

Hemifacial spasm is caused by compression of the facial nerve as it exits the brain by a tortuous blood vessel. This results in “short circuiting” of the facial nerve. The facial twitching only rarely goes into spontaneous remission, and more commonly worsens over months to years. This impairs vision, causes embarrassment and may cause facial discomfort. Approximately 5 to 10 percent of patients may develop hemifacial spasm on both sides of the face. The spasms are usually life long.

Prognosis With Treatment

Botulinum toxin injections substantially reduce or eliminate the eye twitching and lower facial spasms. This improves vision, reduces embarrassment and improves facial comfort. The occasional adverse effects include eye dryness, droopiness of the eyelid, or facial drooping. These adverse effects are usually mild and gradually remit over 2 to 3 weeks. The benefits of the injections are maximized, and the adverse effects are minimized, by customizing the specific dose and pattern of injections for the specific facial muscles involved for each patient.

Oral medications are effective in less than 5 to 10 percent of patients. Brain surgery, involving decompression of the facial nerve by placing a small pad between the facial nerve and the blood vessel compressing it, can be an effective treatment but is much more invasive and has a significant risk of major complications, including stroke and paralysis.

Botulinum toxin injections are now the firstline treatment for hemifacial spasm, because of tremendous efficacy and low incidence of side effects.