HemiFacial Spasm (Facial Twitch)

I have been having problems with a very annoying lower eyelid twitch. The location is the lower eyelid down into the lower eyesocket area.

The twitches can be on both sides at once (not always) and can last from a few minutes to 10-12 hours. Both eyes will not twitch at the same speed or rythm. Like playing the piano with two hands doing different things. It will go on for weeks at a time.

I thought it was a side effect from the meds but my pharmacist doesn't think so-so I did some more research.

I came across HemiFacial Spasm. It is described as a twitch in the facial muscle, often showing its first twitches in the eyelid area. Cause can be a blood vessel pushing on the facial nerve (Trigem. nerve not mentioned) and can be relieved with an MVD.

Does this sound familiar?

My neurologist aleady thinks I have more neuro issues than the TN. He doesn't know about the eye twitches yet.

Any thoughts?

The diagnosis of hemi-facial spasm involves a different nerve (7th cranial nerve) that emerges from the brain stem a few millimeters away from the trigeminal (5th cranial) nerve. Same process, though: generally nerve compression by a blood vessel. Having twitches in both eyelids at the same time is a bit unusual, but still not beyond the state of knowledge about this disorder. It simply means that you've got veins or arteries on both sides doing the same kinds of compression.

Another disorder with overlapping symptoms is so-called "Bells Palsy" which can cause outright paralysis of the facial nerve. Your neurologist may want to evaluate for Herpes Simplex, Herpes Zoster, and Lyme Disease at the same time he or she works you up for hemi-facial spasm.

See http://en.wikipedia.org/wiki/Facial_nerve_paralysis#Bell.27s_palsy

Regards and best,

Red Lawhern, Ph.D.

Resident Research Analyst, LwTN

Thanks Red. I knew it wasn' t the same nerve and it was close the same location, but that's all the info I had. Will look at the link you gave and definately talk to my Neuro. I have been prone to Cold Sores all my life - I had always been told this was Herpes Simplex. No clue if that is accurate. This seems to all be making sense and piecing together nicely.

While I am ATN and my Neuro wants to stay away from an MVD discussion, perhaps this will change things a bit.

I do get asked frequently by my GP about paralysis. I rarely experience any. When I do it is VERY brief, only lasting a minute or two. Again - things seem to be piecing together.

Thanks Red - I was hoping you would have some insight.


Red - follow up Q:

What are the tests for Herpes Simplex, Herpes Zoster and Lyme Disease? Will these tests, Bell's Palsy and the HemiFacial Spasm evaluations be simple blood tests? What should I expect from my Neurologist?

My neurologist was leaning toward doing a new MRI. Not sure what he would be looking for this time. My first MRI was done about 6 years ago and it was the standard - look for tumors, lesions / rule out MS (turned out ok)

Cold Sores are generally caused by Herpes Simplex 1. It's fortunately a different bug from Herpes Simplex 2 which causes genital Herpes. Likewise, there is an article reference in our tab for "Face Pain Info" above, which I think it might be well for you to read in the Knowledge Base at the TN Association. It reports a series of MVDs delivered for both TN and ATN patients whose pain began as the more typical form of TN. And results for the two categories of patients were pretty much the same.

Regards and best,


This gives me so much new information for my next Neuro appointment. I think we came to a bit of head-scratching moment at my last appointment-not knowing which direction to take next so this is a very positive step forward.

Thanks so much Red

To everyone out there reading this stream - sometimes asking the right question in the right way will get you where you need to go. Don't be afraid to post on this site.


Herpes Zoster is detected by blood test, as I recall. Lyme is a much more subtle beaste to track down, but that too is done with blood tests, looking for several genetic factors introduced by the Lyme infection. The earlier article link I sent indicates that these "root causes" are speculated to be associated with emergence of Bells' Palsy and Hemi-facial spasm -- which can be somewhat difficult to separate into two separate diagnoses. There is no "blood test" specifically for Bell's or spasm -- only for potential causes. If you've got active Herpes Zoster in your system, then you might be treated for post herpetic neuralgia as well as for a compression of the 7th cranial nerve.

After six years, I'm surprised nobody has recommended that you do MRI immediately (rather than "leaning" in that direction). If you have MRI done, then request a "trigeminal protocol" administered with 0.66-mm thin-slice MRI done both with and without a contrast agent, and followed by post-procedure 3-D reconstruction. Even this procedure doesn't show all of the potential compressions, so a "negative" MRI reading should never be taken as justification for denying you an MVD. OTHER factors in your health history or pain presentation might bear on that decision, but not the absence of a visible compression. But if a compression is found, that may lend additional credence to a decision to perform MVD.

For your own safety, please remember that my doctorate is in engineering systems, not medicine. And feel free to print out this narrative to take along to your doctor for verification or correction if he/she feels needed.

Go in Peace and Power


Elaine, I have the lower lid twitches as well, I just figured it was part of my ATN. IDK, Min

Thanks Bobby. I wouldn't have thought to actually see an optomitrist or eye specialist in addition to the Neurologist. Will investigate.