Why does a face begin to live its own life?
The facial nerve controls facial muscles. At the point where it exits the brain stem, the nerve sheath is especially thin, and here an artery is often adjacent to it. With age, the vessels lengthen and become more tortuous, so the pulsation begins to constantly injure the nerve. A kind of “short circuit” occurs: impulses spread to neighboring fibers, and the muscles contract on their own. Less commonly, the cause is tumors of the cerebellopontine angle, consequences of previous neuropathy of the facial nerve, multiple sclerosis or vascular malformation.
- Compression of the facial nerve by a vessel is the most common cause
- Consequences of Bell's palsy
- Tumors of the cerebellopontine angle
- Vascular malformations
- Multiple sclerosis
- Rarely - bone anomalies of the skull base
Symptoms and course
The disease develops slowly. First, the orbicularis oculi muscle, usually the lower eyelid, twitches sporadically; It's easy to chalk it up to fatigue. Gradually, the episodes become more frequent and longer, the muscles of the cheek, the wing of the nose, and the corner of the mouth are involved. During severe attacks, the eye closes completely, making it difficult to read and drive. A distinctive feature is that contractions continue during sleep and do not disappear when distracted. Excitement, fatigue, talking, chewing and bright light intensify the spasm.
- Starts with eyelid twitching
- Gradual involvement of the cheek and corner of the mouth
- One-sided nature
- Maintaining contractions during sleep
- Increased by stress and fatigue
- Sometimes - clicking in the ear during spasm
What can be confused with
The most common harmless situation is myokymia of the eyelid, when only the eyelid trembles finely due to lack of sleep, stress or excess coffee. It goes away on its own in a few days and never spreads to the cheek. Blepharospasm is distinguished by the fact that squinting occurs on both sides. Tics can usually be suppressed briefly by force of will, and they change location. Postparalytic synkinesis occurs after inflammation of the facial nerve and is accompanied by residual weakness of facial expressions.
- Myokymia of the eyelid - only the eyelid, goes away on its own
- Blepharospasm - bilateral
- Facial tics - suppressed by will, change
- Synkinesia after facial nerve neuropathy
- Focal epilepsy - requires exclusion for other symptoms
Survey
The diagnosis is mainly made by the clinical picture: the typical unilateral spread of contractions from the eyelid down the face is very characteristic. Nevertheless, magnetic resonance imaging of the brain with a targeted assessment of the vessels in the area of the cerebellopontine angle is prescribed to everyone: it is necessary to exclude a tumor and see the conflict between the vessel and the nerve. Electroneuromyography helps confirm the mechanism and distinguish the condition from other muscle disorders. If there is concomitant hearing loss, an ENT specialist will additionally examine the patient.
- Examination by a neurologist with assessment of facial expressions
- MRI of the brain and blood vessels
- Electroneuromyography
- Audiometry for tinnitus or hearing loss
- Blood pressure control
Treatment
The most effective and safe method is injection of botulinum toxin into the muscles involved in the spasm. The drug temporarily weakens their contraction, the effect develops in a few days and lasts for several months, after which the procedure is repeated. It must be performed by a doctor who knows the technique. Drug therapy with anticonvulsants and muscle relaxants does not help everyone and is more often used as an adjunct. In case of severe spasm and confirmed vascular conflict, an operation is suggested - microvascular decompression, in which a gasket is placed between the vessel and the nerve. Massage, self-massage and electrical stimulation of the face are ineffective.
- Botulinum toxin injections repeated every few months
- Medicines prescribed by a neurologist
- Microvascular decompression if ineffective
- Treatment of the underlying disease in the secondary form
- Adequate sleep and stress reduction as supportive measures
- Blood pressure control
- Refusal of electrical stimulation and warming procedures on the face