Bilateral hemifacial spasm: A report of five cases and a literature review

We describe five patients with bilateral hemifacial spasm evaluated in a Mo vement Disorders Clinic to illustrate the clinical characteristics and to d raw attention to the differential diagnosis of this condition. All patients had unilateral onset followed by bilateral, asymmetric, and asynchronous f acial contractions. The mean age of the patients (4 women and 1 man) was 70 .6 years (range, 54-81 yrs), and the mean duration of symptoms was 17 years (range, 2-30 yrs). The facial twitching started in the left eyelid in all cases and the opposite side of the face began to twitch on the average 8.4 years (range, 0.2-15 yrs) later. Imaging studies revealed tortuous vertebro basilar arteries in three patients. Four patients were successfully treated with botulinum toxin injections. Bilateral hemifacial spasm is a rare, per ipherally induced disorder that must be differentiated from ties, dystonia including blepharospasm and other cranial dystonia, and other facial dyskin esias. Botulinum toxin injection appears to be the treatment of choice.