Hemifacial spasm (HFS), also known as facial muscle twitching, hemifacial spasm, generally refers to primary or idiopathic, manifesting as paroxysmal, rhythmic twitching, spasm or tonic seizure of one side of the facial muscles, the twitching mostly starts from one side of the orbicularis oculi muscle, gradually expanding downward, spreading to the orbicularis oris muscle and facial expression muscle, causing facial pain in severe cases, affecting vision, speech and sleep, the condition The disease progresses slowly and usually does not get better naturally. The pathogenesis of the disease may be due to demyelination of the facial nerve from the brainstem due to compression by abnormal vascularization of the vertebrobasilar system, causing short-circuiting of impulses between the afferent and efferent nerve fibers, resulting in the occurrence of facial twitching symptoms. It is mostly seen in middle-aged women, with the left side being more common. Clinical manifestations: mostly seen in middle-aged women, starting with involuntary twitching of one eyelid, then gradually spreading to the cheek and orofacial muscles, broad neck muscles, initially intermittent, symptoms are gradually more frequent, can be aggravated by emotional stress, fatigue, etc., and can cause facial muscle atrophy in severe cases, cranial CT and MRI examination (but the examination can exclude secondary such as intracranial lesions auditory neuroma, etc.) generally no abnormalities. Differential diagnosis: 1, facial muscle twitching after facial nerve palsy Facial nerve injury or facial neuritis caused by facial nerve palsy, incomplete recovery can produce facial muscle twitching, this facial twitching is often accompanied by contracture of paralyzed muscles or joint band movement (such as involuntary closure of the eyes when opening the mouth), when making voluntary movements such as showing teeth, the facial muscle on the twitching side does not contract, while the contraction of the facial muscle on the healthy side is normal, and the corner of the mouth is crooked to the healthy side. 2, secondary facial muscle spasm Facial muscle spasm caused by pontocerebellar horn tumor, intracranial inflammation, medullary cavitation, motor neuron disease, craniocerebral injury and facial nerve paralysis, etc., mostly accompanied by other cranial nerve damage. 3. Hypochondriacal (functional) blepharospasm is common in middle-aged and older women, mostly bilateral, limited only to the spasm of the eyelids, and the twitching is synchronized bilaterally, while the facial muscles in the lower part of the face are not involved. 4. Habitual facial twitching is common in children and young adults, and is a transient compulsive facial muscle movement, bilateral, and can be temporarily controlled by the will. The muscle contraction on electromyography is the same as that produced during active movement. Treatment: 1, drugs: mainly carbamazepine, phenytoin, baclofen and various sedative and tranquilizing drugs, can reduce the symptoms for a short period of time, later need to increase the drug dose, prolonged use is likely to cause liver and kidney function damage. 2.Chinese medicine: traditional Chinese medicine, acupuncture, etc. 3, botulinum toxin injection method: the mechanism is that botulinum toxin can block neuromuscular transmission, reduce the degree of facial muscle spasm, does not affect the normal nerve conduction, but generally 2-3 months after the relapse (botulinum toxin is metabolized by the body after the recurrence of symptoms), must repeat the injection; cumulative injection of 3 years after the complications of 60%-75%, common complications are: facial paralysis, dry eyes, diplopia, swallowing difficulties, etc. 4, surgery: mainly for apparent microvascular decompression, apparent microvascular decompression is currently the best treatment for facial myasthenia.