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Abstract: The patient visited the clinic for involuntary twitching of the left side of the face, which had seriously affected his daily life. The patient’s left frontal lines became shallow, the corners of the mouth were slightly skewed to the right, the left facial muscles, corners of the mouth muscles, and eye muscles twitched, and there was no obvious abnormality in pain sensation. After the patient was given medication, his left facial involuntary twitching symptoms disappeared and the facial muscle spasm was cured.
Basic information】Male, 47 years old
Disease Type】Myospasm (facial spasm)
Hospital】Beijing Tiantan Hospital
Date of consultation】April 2019
Treatment plan】Oral medication (vitamin B1 tablets, vitamin B12 tablets, gabapentin capsules)
Treatment Period】5 days of inpatient treatment, 2 months of home treatment
【Treatment effect】The patient’s facial twitching symptoms disappeared and the facial muscle spasm was cured
I. Initial interview
The patient came to our hospital because of involuntary twitching of the left side of the face. He reported that the facial twitching often worsened after exertion and stress, which had seriously affected his daily life. The patient’s medical history was asked, and he reported that he had left-sided peripheral facial palsy one year ago, but had no other medical history. On examination, the patient was found to have a shallow left frontal stripe, a slight skewing of the corners of the mouth to the right, twitching of the left facial muscles, corners of the mouth muscles and eye muscles, and no obvious abnormalities in pain. The patient’s head CT and EEG were completed, and the patient’s clinical manifestations were integrated, and the patient was initially considered to have facial spasm caused by peripheral facial neuritis.
II. Treatment history
For further treatment, the patient was admitted to the hospital. After admission, the patient was given nerve-nourishing drugs vitamin B1 tablets and vitamin B12 tablets, as well as oral gabapentin capsules to control the onset of symptoms. During the treatment, the treatment effect was not obvious after 2 days of medication, and involuntary facial twitching was still obvious, so the dosage of gabapentin capsules was appropriately increased and the medication was continued. After the dose change, the patient’s involuntary facial twitching symptoms were relieved and her sleep improved. Occasional episodes of paroxysmal spasms of the left facial muscle did not affect her life. Along with active medication, the patient was also given psychological counseling and advice on daily diet and living habits, and the patient was discharged after 5 days of hospitalization.
III. Treatment effect
The patient had facial muscle spasm caused by peripheral facial neuritis, which was manifested by involuntary facial twitching. After 3 days of using the increased dosage of medication, the patient’s symptoms of involuntary facial twitching improved significantly and the quality of sleep improved substantially.
After the patient was discharged from the hospital, the patient continued the medication for 2 months, and the patient was followed up by telephone.
IV. Precautions
After active treatment, the patient’s involuntary facial twitching disappeared and he is now back to normal life, and I am very happy for the patient. After the patient is discharged from the hospital, he still needs to pay attention to keeping his face warm, avoid washing his face with cold water, use the healthy side to chew food when eating, and should relieve his emotions to avoid emotional anxiety caused by facial muscle spasm. Patients should take the medication as prescribed by the doctor, never stop the medication on their own, continuously observe their own situation, always see if the facial symptoms improve, and if there are any uncomfortable symptoms during the treatment period, they must seek medical attention in time.
V. Personal insight
Facial muscle spasm is usually caused by stimulation of the facial nerve. This patient had left-sided peripheral facial palsy one year ago, which led to facial muscle spasm and involuntary twitching of the left side of the face, but the good thing is that after treatment, the involuntary twitching of the left side of the face disappeared and satisfactory treatment results were obtained.
Although facial muscle spasm will have unilateral muscle involuntary twitching, it is not life-threatening, but most of the facial muscle spasm is not well treated. Fortunately, this patient’s condition was cured, and he no longer had the psychological burden and resumed his normal life.