Summary about Disease
Facial myokymia is a rare, involuntary, fine, rippling or twitching of the facial muscles, most commonly around the eyelids (blepharomyokymia), but it can also involve other facial muscles like those around the mouth or cheek. It's often benign and self-limiting, but in some cases, it can be a symptom of a more serious underlying neurological condition.
Symptoms
The primary symptom is involuntary, fine, worm-like rippling or twitching of facial muscles. It is typically painless. The twitching is usually intermittent and may come and go. It may be aggravated by stress, fatigue, or caffeine. In some cases, it may be accompanied by other neurological symptoms if it's related to a more serious condition.
Causes
The cause of benign facial myokymia is often unknown. Potential triggers include:
Stress
Fatigue
Caffeine or other stimulants
Electrolyte imbalances (rare)
Dehydration More serious, but less common, causes include:
Multiple sclerosis (MS)
Brainstem lesions (tumors, stroke)
Guillain-Barré syndrome
Encephalitis
Medicine Used
For benign facial myokymia, treatment is usually not necessary as it often resolves on its own. When treatment is pursued, options can include:
Quinine: Historically used, but use is limited due to potential side effects.
Anticonvulsants: (e.g., carbamazepine, gabapentin) may be used if twitching is severe or persistent.
Botulinum toxin (Botox) injections: Can temporarily paralyze the affected muscles, reducing twitching.
Beta-blockers: In some cases, may help reduce tremors and twitching. If the myokymia is caused by an underlying condition, treatment will focus on addressing the underlying cause.
Is Communicable
Facial myokymia itself is not communicable. It is not contagious and cannot be spread from person to person.
Precautions
For benign cases:
Reduce stress
Get adequate sleep
Limit caffeine and alcohol intake
Stay hydrated
Ensure a balanced diet If symptoms are persistent or accompanied by other neurological symptoms, consult a doctor to rule out underlying medical conditions.
How long does an outbreak last?
Benign facial myokymia is typically self-limiting. An episode can last from a few days to several weeks or even months. It may resolve spontaneously and then recur at a later time. If it's related to an underlying condition, the duration can vary depending on the condition and its treatment.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical examination: The doctor will ask about symptoms, medical history, and perform a neurological exam.
Electromyography (EMG): This test measures the electrical activity of muscles and can help differentiate myokymia from other muscle disorders.
MRI or CT scan: These imaging tests may be ordered to rule out underlying brainstem lesions or other neurological conditions, especially if other neurological symptoms are present.
Timeline of Symptoms
Onset: Gradual or sudden onset of fine, rippling twitching in facial muscles.
Progression: Twitching may remain localized or spread to other facial muscles. Frequency and intensity of twitching can vary.
Resolution: In benign cases, symptoms typically resolve spontaneously within days to weeks or months. Recurrences are possible. In cases linked to underlying conditions, the timeline is dictated by the underlying condition.
Important Considerations
While often benign, persistent facial myokymia warrants medical evaluation to rule out serious underlying conditions.
If accompanied by other neurological symptoms (e.g., double vision, weakness, numbness, speech difficulties), seek immediate medical attention.
Self-treating with over-the-counter medications is generally not recommended without consulting a doctor.
Proper diagnosis is crucial to determine the cause and appropriate management.