1. (Preferred) For true primary facial spasm, there is no ideal treatment drug (see article on drug treatment options).
Oral drug treatment can be combined with acupuncture, Chinese herbal medicine, massage and other physical therapy during the treatment period, which may briefly relieve the symptoms, but because the cause of the disease cannot be removed.
2. (Secondary option) If drug treatment is not effective and the side effects of drugs cannot be tolerated, Botox injection can be used.
Botulinum toxin injection can reduce the electrical signal transmission of facial nerve and even lead to facial paralysis. The mechanism is not clear, and repeated injections can lead to permanent facial paralysis.
3.(Triple choice) If the drug treatment and botulinum toxin treatment are unsatisfactory, or if the symptoms gradually worsen and the drug and botulinum toxin treatment cannot be tolerated, craniotomy is recommended.
In the United States, Professor Jennatta pioneered microvascular decompression for facial myasthenia in 1967, and the procedure was recognized worldwide by the 1980s. The cure rate is 75%~85%, and the recurrence rate is less than 5%~10%. Currently, it is the surgical method of choice for the treatment of facial muscle spasm.
4, (new progress) there have been reports of gamma knife treatment of facial muscle spasm, effective, still in the phase of clinical efficacy evaluation.
5, (not recommended) percutaneous puncture facial nerve radiofrequency thermal coagulation, facial nerve combing, alcohol closure, etc., the efficacy is not satisfactory.
Pharmacological treatment of facial muscle spasm
Program I.
Deridol (imported carbamazepine), start with 0.1g once, twice a day; increase 0.1~0.2g every other day after the second day until the pain is relieved, maintenance amount 0.4~0.8g daily in divided doses; the maximum amount should not exceed 1.2g daily.
Mecobalamin tablets (methylcobalamin), 1500 μg, orally, usually 1 tablet once, 3 times a day for adults
Option 2.
Oxcarbazepine (Trilostane), dosage: Start with a dose of 300mg/d and gradually increase the dose to 900-3000mg/d to achieve satisfactory efficacy.
Mecobalamin tablets (methylcobalamin), 1500μg, orally, usually 1 tablet once, 3 times a day for adults
Option 3.
Depakene extended-release tablets (imported), 500 mg, orally, once a day
Micropol tablets (methylcobalamin), 1500 μg, orally, usually 1 tablet once a day for adults, 3 times a day
Option four.
Carbamazepine tablets can be used, along with mecobalamin (methylcobalamin) taken orally. However, carbamazepine tablets are a drug with a high level of side effects.
Carbamazepine is a third-generation broad-spectrum antiepileptic drug, in addition to antiepileptic, but also has sedative, anticonvulsant and trigeminal neuralgia inhibiting effect. The current recommendation is to start with a dose of 100 mg per day and gradually increase to 600 mg per day or more, but not more than 800 mg per day. After the pain is relieved, the dose should be reduced and maintained for at least 6 months.
Option 5.
Phenytoin sodium tablets, together with mecobalamin (methylcobalamin) taken orally. However, the side effects of phenytoin sodium tablets are more severe.
Phenytoin sodium is a first-generation broad-spectrum antiepileptic drug with some efficacy against myoclonic spasm, but it is not as reliable as carbamazepine, so it is not preferred. The recommended dosing method is: start with a dose of 100 mg twice a day and increase to 300-400 mg within 2-3 weeks. If the pain is not relieved, the drug should be stopped, and if it is relieved, the dose should be gradually reduced and maintained for more than 6 months.
Note: The above regimens should only be used alone, not in combination!