# Hemifacial Spasms or Focal Aware Seizures: The Role of Video-EEG

## TL;DR

This paper discusses how video-EEG helps distinguish hemifacial spasms from focal aware seizures, using a case study of a patient with persistent symptoms.

## Contribution

The paper presents a case emphasizing the diagnostic value of video-EEG in differentiating HFS from seizures.

## Key findings

- Video-EEG showed high-frequency ipsilateral muscle artifacts in HFS.
- Seizures showed interictal or ictal EEG patterns contralateral to facial contractions.
- The case highlights key diagnostic features for neurologists.

## Abstract

Hemifacial spasms (HFS) are common in neurological practice but can be mistaken for focal aware seizures without appropriate diagnostic workup. We present the case of a man in his 60s admitted for congestive heart failure (CHF) exacerbation, who developed left-sided weakness and HFS during hospitalization. Although his motor symptoms improved after receiving tenecteplase (TNK), the HFS persisted, prompting the use of continuous video-EEG to differentiate between cortical myoclonus and HFS.

Video-EEG is essential for distinguishing HFS from focal aware seizures, identifying high-frequency ipsilateral muscle artifacts in HFS versus interictal or ictal EEG patterns contralateral to facial contractions in seizures. This case highlights key features to aid neurologists in differentiating these conditions.