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Diagnosis of hemifacial spasm has very important implications regarding its treatment. These spasms are usually starting around the eye involving the orbicularis oculi muscle and later spread to other muscles of the face that are innervated by the facial nerve, including the platysma. These symptoms usually persist during sleep and some patients actually complain of a ticking sound on the affected side, which is caused by contraction of the stapedius muscle. Hemifacial spasms usually present as progressive involuntary, irregular clonic or tonic movements of the face for the muscles innervated by the facial nerve. I'm going to show a video of one of my patients who has kindly agreed and consented to have her video shown for teaching purposes. As you see in this video, her left side is affected by the hemifacial spasm. The initial spasms you saw were clonic, and this is now a tonic contraction, as you can see momentarily, where the left side of her face is completely involved with tonic contractions. So clonic contractions are intermittent, while the tonic contraction is a sustained spasm of the entire left side of her face muscles. It is important to note that for a majority of patients who suffer from hemifacial spasm, the spasms initially occur around the eye and then involve the lower part of the face. It only occasionally starts around the lower part of the face and then involve the eye. And it is exceedingly rare for patients for true hemifacial spasm to have both sides of their face involved. Here you can see some clonic contractions. And here's the tonic contraction, where there's sustained contractions on the left side of her face.
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