Why the only cure for actor's facial tic was brain surgery

By Oona Mashta

Brave face: Chris Williams, pictured with girlfriend Laura, left, was alarmed to hear that his facial tic would get worse without a brain operation


Chris Williams was young and confident and loved being on stage as a member of his local amateur dramatic society. So when he developed an uncontrollable intermittent spasm that contorted the right side of his face, the 31-year-old IT systems engineer put it down to nerves over his latest role.

'It was October 2006 and I was rehearsing for the lead in the play Double Cut, by Alfred Shaughnessy, when it started,' says Chris, who lives in Colne, Lancashire. 'I thought I'd taken on too much, as on stage I had to put on a South African accent, play the piano and mix cocktails.'

His GP thought the same. When it started, the tic affected only his right eyelid, but within months it spread across his cheek and mouth, often causing a continuous grimace. After seeing three doctors, who all agreed it was a nervous condition, he researched the problem on the internet.

His symptoms matched a condition called hemifacial spasm, which affects the nerves controlling the facial muscles. To his surprise, Chris found it was a physical condition, not a nervous one.

In July 2007, he visited the UK's leading surgeon in the field, Professor Hugh Coakham, consultant neurosurgeon at Spire Bristol Hospital. Following an MRI scan focusing on nerves in the head, the diagnosis of hemifacial spasm was confirmed.

It is a rare condition, affecting only two in 100,000 people. The first symptom is usually an intermittent twitching of the eyelid muscle. This may gradually spread to the muscles of the lower face, causing the mouth to be pulled to one side and eventually involving all the muscles on one side of the face.

The spasm is caused by blood vessels, veins or arteries irritating the facial nerve close to the brain stem. The artery lies on a nerve sheath that can become worn away by pressure from the artery above it.

Prof Coakham explains: 'The nerve is like an electrical cable insulated with plastic which, if it is worn away, causes a short-circuit, resulting in chaotic facial spasms as the wrong message reaches the brain.'

Occasionally, swallowing is temporarily affected because the swallowing nerve is close to the facial one. A rare side effect can be deafness in one ear.

Chris says: 'It was a huge relief to discover I wasn't suffering from anything life-threatening, but depressing to find out that without complex, invasive brain surgery I would continue to deteriorate.'

Prof Coakham explained to Chris that it was a major operation but it was highly likely it would result in a permanent cure without any serious side effects.
'Microvascular decompression involves gently moving a blood vessel-to a new position where it is fixed with a small Teflon sling,' he says.

'The operation usually takes about two hours and requires three to four days in hospital, but patients take three to four weeks to make a full recovery.'


Heads you win: How Chris's tic was cured


The tic had come to dominate every aspect of Chris's life. At work he used it as an ice-breaker by explaining it before meetings with new clients. 'It was embarrassing as it could look as if I was inappropriately winking at people,' says Chris.

And in 2008, he gave up acting. 'Ironically, in reviews in the past I had been praised for my realistic facial expressions. I was terrified the reviewers would now criticise my face,' he explains.

Throughout, his girlfriend Laura Preston, 22, a graphic designer, was a tower of strength.

Chris says: 'The tic became the third person in our relationship. Every evening we would discuss how bad it had been throughout the day.'

After many discussions with Laura, he opted to proceed with surgery last November.

He says: 'To see my face after the operation was incredible. Laura and my family said my face looked open, and I couldn't stop smiling while the surgeon said that I was a good-looking lad.

'I've got my face back and with it my self-confidence and quality of life. It's wonderful.'

In a study of the operation undertaken by experts at Addenbrooke's Hospital, Cambridge, 80 per cent of patients were permanently cured and 15 per cent reported fewer spasms but said they were not totally over it. In five per cent of cases, the surgery did not help.

The total hospital surgery cost is between £10,000 and £15,000 privately with Prof Coakham at the Spire Bristol Hospital and the operation is also available on the NHS.

The only other treatment available to hemifacial spasm sufferers is Botox injections that temporarily paralyse the muscles.

The results last only three to six months before the patient will need the injections again.

source: dailymail