Hemifacial spasm in the Middle East: Insights from a high-volume tertiary care center

OBJECTIVE: To provide the first comprehensive regional profile of hemifacial spasm (HFS) in the Middle East by analyzing patient demographics, clinical features, treatment patterns, and outcomes. METHODS: We retrospectively reviewed adults (≥18 years) diagnosed with HFS from January 2015 to December 2024. Incomplete records were excluded. Data included demographics, clinical features, imaging, treatments, and outcomes. Severity was rated on a 5-point Likert scale. Chi-square tests determined statistical significance (p < 0.05). RESULTS: Of 240 referred patients, 174 met inclusion criteria. Females accounted for 56 % (male-to-female ratio 1:1.29), with mean age of onset 42 ± 14 years. Left-sided involvement predominated (56.7 %). Primary HFS comprised 64.4 % of cases, secondary HFS correlated with facial pain (p < 0.01) and weakness (p < 0.01). Hypertension showed no association with laterality (p = 0.27). Botulinum toxin injections yielded moderate-to-marked improvement in 92 % of patients, while microvascular decompression achieved sustained relief in 21 of 22 cases. Oral therapy provided modest benefit. Spontaneous remission occurred in 10 patients. CONCLUSION: This first UAE study provides a detailed HFS profile, confirming high efficacy of botulinum toxin and microvascular decompression. Oral therapy may offer supportive, noninvasive benefit. Observed variations in onset age and etiology suggest potential genetic and environmental influences, highlighting the need for prospective multicenter studies in the region.