Extracerebral division into four functional blocks Trauma Vascular Tumor Function
Facial muscle spasm: diagnostic points of trigeminal neuralgia
Facial muscle spasm, commonly known as facial twitching, manifests as paroxysmal involuntary twitching of one side of the face, starting mostly in the upper and lower eyelids and gradually developing to the cheeks and the entire half of the face, with reverse development being less common. It can be exacerbated by fatigue and stress, especially when speaking and smiling, and can become spastic in severe cases. It mostly starts in middle age and is more common in women. In the end, the disease develops into facial paralysis, but combined with facial muscle twitching spasm.
The pathological mechanism is damage to the facial nerve.
In most cases, arterial compression of the facial nerve roots leads to nerve trunk damage and abnormal excitation of the facial nerve nuclei.
In some cases, no artery can be found, including veins.
Diagnostic points of facial twitching: 1) involuntary 2) twitching of muscle bundles 3) associated movements 4) spasticity
Most of the muscle twitches are limited to one side, often occurring first in the lower eyelid, similar to “eyelid jumping”, gradually spreading from the upper to the lower corner of the mouth, upper and lower lips, cheeks, and extending to half of the lateral muscles, and in severe cases, the neck muscles on the same side also appear twitching. If you observe carefully, you can see single bundle of muscles or multiple bundles of muscles contracting rapidly and frequently. This kind of involuntary spasm cannot be controlled by oneself. Chewing, transient eyes or random expression movements can cause facial muscle twitching episodes, which can be triggered or aggravated by factors such as emotional excitement or prolonged reading. The patient’s eyelids are tightly closed and the corners of the mouth are crooked. Generally, each seizure lasts from a few seconds to a few minutes, and the length of the interval is variable. During the seizure, the patient is distracted, unable to see clearly, occasionally has facial pain, nasal congestion and headache, and generally does not have seizures during sleep.
1.Secondary facial muscle spasm
Tumor or inflammation of the pontocerebellar angle, pontocerebellar tumor, brainstem encephalitis, medullary cavernous disease, motor neuron disease, and craniocerebral injury can all present with facial muscle spasm, but often accompanied by other cranial nerve or long bundle damage. For example, ipsilateral facial pain and facial hyperalgesia, hearing impairment, contralateral or extremity muscle weakness, etc. Facial myospasm is only one of its symptoms and is not difficult to differentiate.
Personal opinion Most of the facial muscle spasms secondary to tumors are caused by tumors pushing on the facial nerve.
In the case of large auditory neuroma, we have all seen the extension of the facial nerve with mild facial palsy but no facial muscle spasm.
2. Hysterical blepharospasm
Hysterical blepharospasm is common in middle-aged female patients, mostly bilateral, and is limited to spasm of the eyelid muscle only, while the facial muscle in the lower part of the face is not involved.
3. Habitual muscle twitching
Habitual facial muscle twitching is common in children and young adults, and is a brief forced facial muscle movement, often bilateral. It is a small spasm with purposeless stereotyped or repeated jumping of facial muscles, which is seen on one side and mostly develops in childhood. Obsessive-compulsive, associated with psychogenic factors.
The EMG and EEG of hysterical blepharospasm and habitual facial muscle twitches are normal, and the same muscle contraction waves appear on the EMG during the twitches as those produced during active movement.
Question 1: How to distinguish between spontaneous and involuntary twitching.
Personal tip 1: Ask the patient to stare at your nose or fingers without blinking and observe whether there is still throbbing.
4. Painful twitching
It is a concomitant symptom of trigeminal neuralgia and is also good for identification
Hysterical blepharospasm cannot be examined when hysteria develops
It is not the onset of hysteria either
Personal opinion 2: cranial nerve disease depends on clinical symptomatology to confirm the diagnosis
This is why I want to talk about diagnosis today. Experience is important in clinical symptomatology.
In other words, cranial nerve disorders cannot be diagnosed by imaging.
5, chorea and tardive dyskinesia can have involuntary twitching of facial muscles, but both are bilateral and both are accompanied by similar involuntary movements of the extremities, which can be differentiated. Hand-foot twitching and chorea caused by lesions of the midbrain and conus system
6. Facial muscle twitching of facial palsy sequelae
Idiopathic viral facial neuritis, the sequelae of facial palsy, in addition to facial muscle paralysis of varying degrees, may also leave behind facial muscle associated movements, in short, mouth twitching when blinking, eye twitching when moving, which is the most common associated movement of the orbicularis oris muscle and orbicularis oris muscle.
Question 2: Why is there a cascade of orbicularis oris and orbicularis oris muscle movements in the sequelae of idiopathic viral facial neuritis and facial palsy?
Personal opinion 3: Viral invasion of the facial nerve causes nerve edema and demyelination changes, and nerve fiber short-circuiting during injury and repair.
However, it is important to remember that most of the symptoms of facial muscle spasm have associated movements.
In other words, in addition to involuntary muscle bundle tremors, there are mostly voluntary cascade movements.
Question: How to check for such cascade movements?
Personal tip: Have the patient stare at your raised finger, blink, or puff out the cheeks, or expose the upper teeth, and observe the synchronized movements of the orbicularis oris and orbicularis oris muscle.
In post-facial palsy, there can be voluntary cascade movements, but there must be no involuntary muscle bundle tremors.
7. Eyelid flutter.
I do not know if EMG can distinguish between voluntary involuntary
How to identify involuntary?
Because there is no eyelid jumping to see my clinic
Personal experience: 1 eyelid jumping mostly upper eyelid 2 jumping not more than a day or two
I don’t know if I can put a piece of paper on my facial muscle spasm
The lower eyelid jumping has not tried the paper
There should be nucleus impulse or pulse bioelectricity
8. Meige syndrome
Meige syndrome, also known as blepharospasm-oral and mandibular dystonia syndrome, is characterized by blepharospasm on both sides, with dystonia of the orofacial, facial, mandibular, laryngeal and cervical muscles, and is more frequent in older women.
9. Facial dyscinesia caused by neuropsychotic depressants
New history of taking strong tranquilizers such as fenadine, trifluoperazine, haloperidol, or metoclopramide (gastric reassurance), manifested as forced opening or closing of the mouth, involuntary tongue extension or curling, etc.
The above nine differential items are used to understand the key points of facial twitching diagnosis: 1) involuntary 2) muscle bundle twitching 3) linked movements 4) spastic state
Meige syndrome and neuropsychiatric depressant-induced facial dyscinesia can have similar manifestations of spasticity of facial muscles
Pathological mechanism of facial muscle spasticity
Personal opinion: Damage to the facial nerve short-circuits the formation of epileptiform circuits with the facial nucleus, and the spasticity of the facial muscle is relieved by neurotransmitter depletion
This is a characteristic of facial spasm. It is unlikely to develop bilaterally Only the onset of each can be rushed together.