In 2008 a 54-year-old man with a 5-year history of left-sided hemifacial spasm (HFS) who, after treatment with levetiracetam (dosage, 500 mg bid), showed a marked improvement in condition. After 7 months of therapy with levetiracetam, the patient remains symptom free with no adverse drug reactions.

Levetiracetam proved its effectiveness and safety in the treatment of a case of HFS.Nevertheless, there is a need for further controlled studies with larger samples ¹⁾.

Kuroda et al., experienced two elderly hemifacial spasm (HFS) patients who exhibited a marked response to levetiracetam (LEV) without side effects. Although the exact underlying pharmacological mechanism remains unknown, we assume anti-kindling effect as one of the important pharmacological mechanism underlying the effect of LEV against HFS. Moreover, LEV is considered to be suitable for use in elderly patients because of its good tolerability. In addition, the lack of hepatic induction or inhibition makes it an easy and safe drug when used in addition to other anticonvulsants. Although the long-term benefit remains unknown, LEV may represent an alternative treatment for elderly HFS patients who are unable to undergo or decline surgical intervention and/or botulinum toxin injections or are intolerant to other anticonvulsants ²⁾.