A Chinese expert consensus on the management of facial spasm was published in the November 20, 2014 issue of the Chinese Journal of Microinvasive Neurosurgery.
The main points of the recommendation are as follows.
I. Overview
Facial muscle spasm (HFS) is a recurrent paroxysmal, involuntary twitching of one or both facial muscles (orbicularis oculi, expression muscles, orbicularis oris), aggravated by emotion or tension, and in severe cases, difficulty in opening the eyes, distorted corners of the mouth, and twitch-like murmurs in the ear.
It is more common in middle-aged and elderly people, with slightly more women than men, and the age of onset is trending younger. Although most facial muscle spasms are located on one side, bilateral facial muscle spasms are not uncommon.
Diagnosis
The diagnosis mainly depends on the characteristic clinical manifestations, and the related auxiliary examinations include: electrophysiological examination, imaging examination, and carbamazepine treatment test.
Electrophysiological examinations include electromyography (EMG) and abnormal muscle response (AMR) or lateral spread response (LSR) testing.
Imaging studies include CT and MRI to identify intracranial lesions that may be causing the facial spasm.
3. Patients with facial myasthenia are generally effective on carbamazepine treatment at the beginning of the disease (a small number of patients may be ineffective).
Differential diagnosis
1, bilateral blepharospasm: manifested by recurrent episodes of involuntary eye closure of both eyelids, often with simultaneous onset of bilateral eyelids, the patient often shows difficulty in opening the eyes and reduced tears, with the prolongation of the disease, the symptoms are always confined to the bilateral eyelids.
2, Meijer syndrome: patients often start with repeated episodes of involuntary eye closure of the eyelids bilaterally, but with the prolongation of the disease, there will gradually appear involuntary twitching of the muscles below the eye fissures, manifesting as involuntary abnormal movements of the face bilaterally, and with the aggravation of the disease, the scope of muscle spasm will gradually expand downward, even involving the muscles of the neck, limbs and trunk.
3. Bite muscle spasm: It is a spasm of unilateral or bilateral masticatory muscles, and patients may have different degrees of upper and lower jaw bite disorder, teeth grinding and mouth opening difficulties, and trigeminal nerve motor branch lesion is one of the possible causes.
4. post-facial palsy: it is manifested by restricted movement of the ipsilateral facial expression muscles, involuntary twitching of the ipsilateral corners of the mouth as well as concomitant movement of the corners of the mouth and eyelids, which can be identified based on the exact history of facial palsy.
Treatment
Medication: Commonly used drugs include carbamazepine, oxcarbazepine and Valium, etc. Alternative drugs are phenytoin sodium, clonidine, baclofen, topiramate, gabapentin and haloperidol, etc.
2. Botulinum toxin injection: commonly used drugs for injection of botulinum toxin type A.
3, microvascular decompression: indications include: the diagnosis of primary facial spasm is clear, and secondary lesions are excluded by cranial CT or MRI.
Patients with severe symptoms of facial muscle spasm, which affects daily life and work, and patients with strong willingness to operate; patients treated with drugs or botulinum toxin should be operated actively if there is poor efficacy, ineffectiveness, drug allergy or toxic side effects; patients with recurrence after MVD surgery can be operated again; patients with MVD
Patients who are ineffective after surgery may be considered for early reoperation if the first surgical decompression is considered inadequate and the postoperative AMR test is positive.
V. Complications
Common complications include: cerebral neurological dysfunction, cerebellar and brainstem injury, cerebrospinal fluid leakage, low intracranial pressure syndrome, other complications, etc.