They are involuntary, involuntary, spontaneous contractions of the muscles in the eye, mouth, and sometimes neck area, time and time again. Facial twitches typically begin around the eyes and then spread to other facial muscles around the mouth. While twitches occur very rarely at first, they become more frequent later on. Twitches mostly increase during fatigue, stress, anxiety and excitement, and decrease during rest and sleep.
General characteristics of facial twitches: this disease100 000 It is seen in 14-15 in women and 7-8 in 100 000 men. Although they are most common between the ages of 40 and 60, the incidence is up to 40 per 100,000 people in their 70s. Women are affected twice as often as men. Familial transmission has been reported in 1-2% of all facial twitches.
Clinical features of facial twitches: Facial twitches are a chronic disease with intermittent movements, and patients suffer from painless, repetitive, transient trembling movements in the facial muscles. they mention. Intermittent irregular contractions occur in the muscles on one side of the face, and these contractions begin in the muscles around the eyes on one side, and then appear in the muscles around the mouth and sometimes even in the neck muscles. These involuntary movements cannot be stopped by the patient, especially they increase during excitement, anxiety, speaking, chewing and effort, and can be observed in 80% of cases during sleep
Cause and formation of facial twitches: Facial twitches are classified in two groups:
1: Primary facial twitching: The general characteristic of this type of facial twitching is that there is no facial nerve paralysis on the same side, there is no lesion other than arterial compression, and it has a chronic course. In such patients, an artery puts pressure on the facial nerve and prevents the physiological transmission in the nerve, causing twitching. 2: Secondary facial twitching. Usually, other underlying diseases are responsible for facial twitching; (Head trauma, brain tumors, cerebrovascular diseases, multiple sclerosis)
Diagnosis of facial twitches: A comprehensive neurological examination: observing the movements of facial muscles in facial twitches is very important in the diagnosis of this disease. The patient's talking or excitement is It makes the twitches, which are the appearance of the stone, visible. Neurological examination is usually normal in primary facial twitches. On the other hand, in secondary twitches, the disease may cause neurological findings related to the compression of the cerebellum or other adjacent brainstem nerves. Brain Magnetic Resonance (MRI) technique, one of the imaging methods in diagnosis, reveals the cause of both primary and secondary facial twitching. When using this technique, it is especially important to conduct research and examination of the facial nerve.
3: EMG (electromyelography) technique, one of the physiological conduction studies of the facial nerve, is important to distinguish some diseases that mimic this facial nerve.
Differential diagnosis of facial twitches:
1: Facial tic: It is the presence of similar involuntary movements in other muscles of the body other than the facial muscles. Its difference from hemifacial spasm is the partial suppression of movements.
2: Blepharospasm: It is distinguished from hemifacial spasm by the involvement of bilaterally symmetrical and synchronous eye muscles.
3: Oromandibular dystonia: repetitive and There are continuous contractions, the eye muscles are not involved.
4: Facial myokymia: These are continuous and wave-like involuntary contractions in the facial muscles.
5: Tardive dysnesia: Stereotypic movements in the face, neck and arms. Torso movements and facial grimacing movements are typical.
6: Focal epileptic seizures: Focal epilepsy affecting one half of the face interferes with facial twitching.
7: Psychogenic: They do not sleep at night.
Treatment of facial twitching: Medical treatment:The purpose of the drugs used here: carbomezapine, anticholinergics, baclofen, haloperidol, gabapentin, and others is sedation. Perhaps these drugs can only be considered in mild cases and in patients for whom surgical techniques cannot be applied. Apart from this, facial twitching should not be considered as a treatment option. The effect of this treatment is limited.
Botilinium toxin injection: It causes loss of neuronal activity in the target organ by inhibiting the acetylcholine synapse.
Surgical treatment: This is the treatment option. radical and gold standard treatment for the disease The procedure is surgical microvascular decompression (MVD). There are two main indications for this surgical treatment option.
1: When repeated botox injections or medical treatment options are applied,
2: When all kinds of drug treatment options are applied. ,
Surgical treatment may be recommended for those whose facial twitching affects the patient's living conditions.
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