Can blepharospasm and hemifacial spasm spontaneously resolve? A long-term review of facial spasm patients from two large medical centers

Purpose: To examine and report the long-term natural history of benign essential blepharospasm (BEB) and hemifacial spasm (HFS) patients treated in the botulinum toxin facial spasm clinic and identify and examine any cases of resolution. Methods: This is a retrospective cohort study of all patients who were or still are being treated with Botulinum toxin injections for BEB or HFS from University Hospitals Sussex (UHS), UK and Rabin Medical Center (RMC), Israel, between 2000 and 2024. Patients who ceased treatment were examined in greater detail to identify the reasons for stopping treatment and the likelihood of spontaneous resolution of spasms. Results: The study included 233 patients. The median age at diagnosis was 65 (IQR = 17) years, and 141 (60.5%) were female. 162 (69.5%) patients had BEB and 71 (30.5%) HFS. Of the HFS patients, 40 (56.4%) had right-side spasms. The overall median follow-up time was 52 months (IQR = 79.5). The patients were divided into four groups based on their treatment status. Group 1 (57.9%) – patients who were still receiving Botulinum toxin treatment, or had received it until they died, Group 2 (5.2%) – patients with symptom resolution, who did not require further treatment, Group 3 (30%) – patients who discontinued treatment with no clinical improvement, and Group 4 (6.9%) – lost to follow-up. Conclusions: Facial spasms are usually a lifelong condition. However, contrary to general thinking, there is a 5% chance of long-term spasms resolving, although predictors for resolution remain elusive.