The Hidden Burden of Hemifacial Spasm: A Systematic Review of Non-Motor Symptoms.

[BACKGROUND] Hemifacial spasm (HFS) is a chronic neurological disorder characterized by involuntary contractions of facial muscles. Traditionally regarded as a motor condition, HFS encompasses a spectrum of non-motor symptoms that are often overlooked but significantly affect patients' quality of life.

[OBJECTIVES] This systematic review aimed to synthesize current evidence on the prevalence and clinical relevance of non-motor manifestations in HFS.

[METHODS] A systematic search was conducted across PubMed, Cochrane, and EMBASE databases up to June 29, 2025, following PRISMA guidelines. Eligible studies included cross-sectional, cohort, case-control, and case series designs reporting pain, psychiatric symptoms, or sleep disturbances in HFS. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools according to study design.

[RESULTS] Twenty-two studies met inclusion criteria. Headache was reported in varying frequencies, ranging from 24.2% to 60% of cases, and facial pain in 33.3%, both frequently improving after botulinum toxin (BoNT) therapy. Psychiatric comorbidities were prevalent, with depression and anxiety reported in 5.7% to 29% and 9.1% to 19.5% of patients, respectively. Sleep disorders, mainly insomnia, occurred up to three times more often in HFS patients than in controls. BoNT therapy demonstrated beneficial effects beyond motor control, reducing pain, anxiety, and depressive symptoms.

[CONCLUSION] HFS is a multidimensional disorder with substantial non-motor burden. Recognition and management of pain, psychiatric, and sleep-related symptoms are essential to improving treatment outcomes and overall patient well-being.