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Abstract: Ms. Wang, 58, started with orofacial twitching 2 months ago and reported frequent attacks during the day, but she felt no attacks at night after going to sleep, with previous facial neuritis for 1 year and slightly crooked corners of the mouth. CT examination of the head showed bilateral multiple lacunar cerebral infarcts, and no abnormalities were found in EEG and orbicularis muscle electromyography. Combining the patient’s symptoms, medical history and examination results, facial myoclonus was considered. After administering targeted medication, the patient’s discomfort was relieved.
Basic information】Female, 58 years old
Disease Type】Facial spasm
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (mecobalamin injection + hemosiderin injection + carbamazepine tablets + vitamin B1 tablets + eszopiclone tablets)
Treatment period】8 days of inpatient treatment
Effectiveness of treatment】Symptoms of orofacial twitching were relieved
I. Initial consultation
The patient, Ms. Wang, came to our hospital in January 2022. She reported that she had left-sided orofacial twitching since 2 months without any obvious cause, mostly occurred when the amplitude of facial expressions was large, and occasionally after improvement, she had left-sided orofacial tightness, accompanied by left-sided facial pain, headache after sweating in front of the forehead, continuous swelling and pain, which was relieved after about 1 hour, along with nausea, occasional vomiting, the vomit was stomach contents, no facial Numbness, so he came to our outpatient clinic. The patient said he had facial neuritis for one year, usually had poor sleep, and had a normal diet and normal bowel movements. A CT head examination showed bilateral multiple lacunar cerebral infarcts, and the patient was admitted to the hospital as an outpatient with facial spasm.
II. Treatment history
After admission, the patient was examined: clear, clear speech, body temperature of 36.6℃, blood pressure of 110/70mmHg, heart rate of 75 beats/min, respiration of 17 breaths/min, peripheral facial palsy on the left side, no auditory hypersensitivity; magnetic resonance examination of the head showed multiple lacunar cerebral infarcts and multiple stenosis of cerebral vessels; no significant abnormalities in the electromyography of the orbicularis muscle and no abnormal discharge waves of epilepsy in the electroencephalogram.
We communicated with the patient and his family about his condition and treatment plan: based on the examination results and symptoms, we considered that the patient’s disease was facial spasm, which might be related to anterior neuritis, and could be controlled with good treatment, and suggested targeted medication. The patient expressed his willingness to actively cooperate with the treatment, so he was given methylcobalamin injection to nourish the nerves, hemosiderin injection to improve circulation, carbamazepine tablets to control spasm, vitamin B1 tablets to nourish the nerves, and eszopiclone tablets to improve sleep.
III. Treatment effect
After 8 days of treatment, the patient’s orofacial twitching symptoms were relieved, and symptoms such as tightness of the corners of the mouth and headache were significantly reduced. However, because the patient had suffered from facial neuritis for a slightly longer period of time, the recovery of symptoms of mouth twitching was limited. At the same time, the patient reported improvement in sleep and disappearance of nausea and vomiting symptoms. Considering that the patient had recovered to a certain extent, subsequent rehabilitation acupuncture treatment could be performed, which would also be helpful in relieving the symptoms of twitching at the corners of the mouth, so discharge was granted.
IV. Notes
We are glad that the patient’s symptoms have been relieved after the treatment. After discharge from the hospital, we need to pay attention to a light diet, eat more fresh vegetables and fruits, coarse grains, beans and fish, but avoid stimulating foods to avoid aggravating discomfort; pay attention to the warmth of the head and face, do not blow against the air conditioner, try not to wash your hair and face with cold water; pay attention to the protection of the head and face when you go out in winter, and try not to open the window on the same side when driving in a car; pay attention to maintaining a happy mood, and also do some functional exercises, you can Apply hot towels; ensure sufficient sleep and strengthen physical exercise.
V. Personal insight
Facial muscle spasm is an involuntary intermittent irregular painless tonic clonic jerking of one or more muscles innervated by the facial nerve, and the onset of most patients is related to the compression of the facial nerve root. The prognosis is also better. In the case of this disease, surgical treatment, such as peripheral neurotomy and facial nerve microvascular decompression, is also available for patients who do not respond well to pharmacological treatment.