Facial hemispasm. Facial paraspasm. Blepharospasm

Hemifacial spasm (facial hemispasm, Brissot's disease) is a symptom complex of unilateral hyperactive dysfunction of the facial nerve, manifested by voluntary contractions of the muscles of half the face, caused by compression of the facial nerve root in the area of ​​its exit from the brain stem. According to American authors, hemifacial spasm occurs in approximately 0.8 cases per 100,000 population per year. Hemifacial spasm occurs more often in women (14.5 cases per 100,000), usually in the elderly. In men, hemispasm occurs in 7.4 cases per 100,000.

Causes of hemifacial spasm

There are several causes of hemifacial spasm. Typically, hemispasm is caused by compression of the facial nerve root by a vessel (most often, this is the anterior inferior cerebellar artery, but compression of the root by the posterior inferior cerebellar artery, superior cerebellar artery, vertebral artery, labyrinthine artery, basilar artery, and also branches of the anterior inferior cerebellar artery is possible). Less commonly, compression by vascular malformations or veins is possible. The cause of hemifacial spasm can sometimes be benign tumors or cysts in the cerebellopontine angle, foci of demyelination in multiple sclerosis, adhesions, bone deformities, as well as tumors of the 4th ventricle, brain stem, and cerebellum.

Symptoms

Involuntary movements of the facial muscles are the only symptom of hemifacial spasm. Fatigue, anxiety or reading can speed up movements. Spontaneous hemifacial spasm involves facial spasms, which are myoclonic spasms and are similar to segmental myoclonus, which can occur in other parts of the body. Postparalytic hemifacial spasm, such as after Bell's palsy, manifests as facial synkinesis and contracture.

There are a number of conditions similar to hemifacial spasm.

Spasm of the masticatory muscle

Hemispasm of the masticatory muscle is similar to hemifacial spasm and occurs when the motor trigeminal nerve is irritated. This is a rare condition that is segmental myoclonus, and is manifested by unilateral involuntary contractions of the muscles innervated by the trigeminal nerve (mastication). As with hemifacial spasm, hemispasm of the masseter muscle is well treated with medication and botulinum toxin. In addition, there is evidence that surgical treatment may be effective in some cases.

Myoclonic movements

Myoclonic movements in the facial muscles can also occur with lesions of the brain or brain stem. They differ from hemifacial spasm in the distribution of abnormal movements (more generalized, possibly bilateral), and can be diagnosed by neurophysiology. Imaging techniques can reveal deeper causes. Central myoclonus responds well to anticonvulsant therapy.

Oromandibular dystonia

Oromandibular dystonia is a muscular dystonia that affects the lower musculature of the face, primarily the jaw, pharynx and tongue. When oromandibular dystonia occurs in combination with blepharospasm, it is called Medge's syndrome.

Botulinum therapy is most effective in the treatment of oromandibular dystonia. Medications are also used to a certain extent for oromandibular dystonia.

Craniofacial tremor

Craniofacial tremor may be associated with essential tremor, Parkinson's disease, thyroid dysfunction, and electrolyte imbalances. This condition rarely occurs in isolation. Focal motor seizures sometimes need to be distinguished from other facial movement disorders, particularly hemifacial spasm. Postictal weakness and increased involvement of the lower face are hallmarks of focal motor seizures.

Chorea of ​​the face

Facial chorea occurs in the context of a systemic movement disorder (eg, Huntington's disease, Sydenham's chorea). Chorea is an episodic complex of movements without a pattern. A similar condition, spontaneous orofacial dyskinesia, occurs in older edentulous people. As a rule, the installation of prostheses gives a good effect.

Tiki

Facial tics are short, repetitive, coordinated spontaneous movements of grouped muscles of the face and neck. Tics may occur physiologically or due to diffuse encephalopathy. Some medications (eg, anticonvulsants, caffeine, methylphenidate, antiparkinsonian drugs) may cause tics. Single, repetitive, stereotypical movements are characteristic of tics.

Facial myokymia

Facial myokymia manifests itself as worm-like twitching under the skin, often with a wave-like distribution. This condition is distinguished from other abnormal facial movements by the characteristic EMG discharges, which are short, repeated bursts of motor unit potentials in the range of 2-60 Hz, with periods of silence of up to several seconds. Facial myokymia can occur with any process in the brain stem. Most cases of facial myokymia are idiopathic and resolve on their own within a few weeks.

Drug treatment of hemifacial spasm

Treatment of hemifacial spasm most often begins with drug therapy. Typically, drugs from various pharmacological groups are used: baclofen, carbamazepine, gabapentin, clonazepam. However, due to the fact that facial hemispasm requires regular use of the above drugs, it is necessary to take into account their side effects, which cannot but affect the lives of patients. The effect of drugs from these pharmacological groups was studied in small samples of patients, without placebo control, so it seems doubtful. Botulinum toxin type A is used quite widely in the treatment of HFS, which is injected subcutaneously or intramuscularly into the affected muscles. Significant regression of symptoms is observed in 70-75% of cases, however, injections must be performed every 3 months, the cost of the drug is high, and in 2-14% of cases complications such as facial muscle paresis, ptosis, keratitis, diplopia, drooling, and strabismus are observed.

How to stop facial hyperkinesis. Administration of Botulinum toxin A

Botulinum toxin A (Botox, Dysport) is a means of reducing the excitability of the muscles involved in hyperkinesis. The drug is one of the most convenient options for the symptomatic treatment of spasms of the muscles of the face and eyes, and other hyperkinesis. We inject Botulinum Toxin A using a syringe with a very thin needle directly into the affected muscle, after which the muscle stops engaging in tics or other hyperkinesis. The effect develops within 3-5 days and lasts up to 4-8 months. During this time, a course of treatment of the causes of the disease and rehabilitation procedures (massage, gymnastics, physiotherapy, psychotherapy, cosmetic procedures) are carried out.

Prevention

The best prevention of involuntary muscle contractions is moderate physical activity. Regular exercise helps keep your muscles under control. The tissues will not suffer from physical inactivity or sudden overload. This is equally beneficial for both men and women at any age.

A set of exercises to prevent cramps always includes stretching. It is useful to do it before bed so that unpleasant symptoms do not occur at rest.

Since muscles often cramp due to hypovitaminosis and lack of microelements, it is important to eat a balanced diet. If you cannot get them in sufficient quantities from food, you should additionally take vitamins B and E, as well as magnesium, calcium and potassium supplements. It is also important to drink enough fluids, because similar discomfort occurs due to dehydration.

Information about the disease

The facial nerve is responsible for ensuring the movements of facial muscles, the lacrimal gland, the tensor tympani muscle, and also innervates the anterior two-thirds of the tongue. It leaves the skull in a narrow canal located deep in the temporal bone. The slightest swelling in this area leads to compression of the fibers and the development of corresponding symptoms.

The pathology most often occurs in middle-aged people, who often neglect preventive measures due to the high pace of life. The peak incidence occurs in the cold season, since low temperatures are one of the provoking factors.

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general information

For the first time, the characteristics of this disease were given by the German doctor F. Schulz in 1875, and later in 1884, the French neuropathologist E. Brissot described it in more detail. In connection with the name of the last doctor, hemifacial spasm can be found in the medical literature as Brissot's disease.

Pathology occurs more often in women (about 1.5-2 times). The age range includes people over 40 years of age. Some medical sources indicate that Asians are more susceptible to this disease. This is associated with the ethnic characteristics of the structure of the skull.

Most often, hemifacial spasm affects one side of the face, but there are extremely rare exceptions when both sides are affected.

Diagnostics

The diagnosis is made on the basis of complaints, anamnesis, clinical data and additional examination methods by a neurologist. In case of hearing impairment, consultation with a related specialist - an otorhinolaryngologist is required.

Additional research methods include:

• 
  Electromyography. Registers an abnormal muscle response to stimulation of the branches of the facial nerve.

• Magnetic resonance imaging of the brain. Allows you to identify pathological formations.
• Cerebral MR angiography. With its help, you can trace the topography of anatomical structures relative to each other, in particular this concerns neurovascular conflict.
• Differential diagnosis is carried out with idiopathic blepharospasm, the main difference of which is the displacement of the eyebrow closer to the orbit when the eyelids close. HFS is also differentiated from psychogenic spasm, facial myokymia and paroxysms of focal epilepsy.

Incidence (per 100,000 people)

Who usually experiences muscle cramps?

This trouble is familiar to everyone: men and women, children and the elderly, athletes and office workers. Only some people get to know her for natural reasons and rarely encounter her, while for others she becomes a frequent companion.

The risk group includes:

• children under 3 years of age who have experienced a rise in temperature above 38 degrees;
• elderly people suffering from vascular diseases and muscle atrophy;
• men engaged in heavy physical labor;
• athletes (football players, swimmers, runners);
• people who abuse alcohol and often experience hangovers;

Predisposes to muscle spasms and pregnancy. In mild cases, they are caused by a lack of vitamins due to changes in the body; in severe cases, they are caused by eclampsia.

Consequences of jaw spasm

Trismus is unpleasant for a person not only due to pain. When opening and closing the mouth is painful, the normal process of eating is disrupted and the gastrointestinal tract suffers. When the jaw spasms, breathing is impaired, which leads to constant oxygen starvation of the brain and headaches. This affects the composition of the blood and the functioning of the cardiovascular system.

Trismus caused by infections or tumors causes serious health problems. In this case, long-term serious treatment is required. In the initial stages, pain is completely relieved. For systemic diseases, when trismus is a secondary symptom, complex therapy is necessary.

Symptoms of inflammation of the trigeminal nerve

Experts include short-term, but acute and intense pain in different parts of the head as the main symptoms of facial neuralgia. Shooting attacks spread over the entire surface of the face - lips, eyes, nose, upper and lower jaw, gums and tongue.

Patients also report the following symptoms:

• Metallic taste in the mouth
• Muscle weakness
• 2-3 days before facial expressions are affected, pain occurs behind the outer ear, spreading to the face, back of the head and eyes
• Facial asymmetry
• Inability to close the eye on the affected side
• Drooping corner of the mouth
• Dry mouth
• Slurred speech
• Cross-eyed strabismus
• Uncontrollable tearing
• Disorders of taste buds
• Increased drooling
• Facial muscle spasms
• Increased or decreased facial sensitivity
• Temperature increase

Due to discomfort and pain, the patient begins to develop a phobia and increased anxiety. He tries to avoid poses and movements that provoke discomfort.

Prevention of hypertonicity of the TMJ muscles

Preventive measures against hypertonicity of the lower jaw muscles will help prevent the disease with an integrated approach. It is much easier to follow the general recommendations of doctors than to face a painful spasm of the TMJ. Prevention includes the following activities:

• Preventive visits to the doctor every six months.
• Careful systematic oral hygiene.
• Treatment of caries at its first symptoms.
• Orthodontic treatment for malocclusion pathologies.
• Disinfection of food products.
• Antitetanus therapy for animal bites.
• A set of necessary vaccinations.
• Do not open your mouth wide (jaw dislocations often occur when trying to bite off a large fruit).
• Do not overuse solid foods and do not chew nuts with your teeth.
• Avoid stressful situations, react less to stress.

Classification

Depending on the etiological factor causing the development of pathology, hemifacial spasm is divided into two groups:

• Primary. It occurs as a result of the special anatomical location of the blood vessels and the nerve itself.
• Secondary. It develops as a result of external influences or any pathological processes occurring in the body.

Based on the root cause, the GFS is conditionally divided into:

• Typical. Inherent in the primary form, it manifests itself as an isolated contraction of the orbicularis oculi muscle.
• Atypical. Observed more often in the secondary form, spastic contractions are localized in the forehead, eyes and, as a rule, begin from the cheeks and lips.

Why do muscles cramp in pregnant women?

Carrying a child leads to significant changes in the body. In particular, metabolism is rebuilt. As a result, many expectant mothers are faced with magnesium deficiency, which is why cramps appear.

Pregnant women's legs are subject to greater stress due to weight gain. Hence the involuntary muscle contractions that occur in the evenings and at night. They can also be triggered by varicose veins, which often accompany hormonal changes.

Pregnant women often complain about back pain. The lumbar spine is under constant tension, forced to bend under the pressure of the uterus, so such sensations are normal. Therefore, expectant mothers are recommended to lie on their side to relieve the load on the spine.