Craniofacial Muscles

16 Spastic Facial Muscle Disorders
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16.11 Eyelid/Facial Tics
Eyelid tics are brief, stereotyped, repetitive, and involuntary eyelid blinks, winks, or
blepharospasm (Evidente and Adler 1998 ) . Tics may be preceded by a premonitory
urge to perform the movement, which increases until the movement is fi nished. This
premonitory urge may be an unpleasant feeling, such as burning, tension, or a contraction.
A tic may be temporarily suppressed by willpower, but the next time it
occurs, it will often be more violent and explosive.
Tics can be classi fi ed as motor or phonic. Motor tics usually reproduce a normal
movement such as blinking or raising the shoulders. Any muscle can be involved,
but mostly tics occur in the muscles of the face, neck, and shoulders. Phonic tics are
involuntary sounds produced by moving air through the nose, mouth, or throat (e.g.,
grunting) or words, sometimes obscene (coprolalia)
Tics are often idiopathic and considered benign. They also can be associated with
encephalitis, drugs, toxins, stroke, and head trauma. In some instances, eyelid tics
are a fi rst manifestation of Tourette’s syndrome. This is a childhood disorder, affecting
boys more than girls, in which multiple motor tics in eyelid, face, limbs, or body
are combined with one or more phonic tics. Characteristic behavioral manifestations
include obsessive-compulsive disorder, grunting, throat clearing, barking, coprolalia,
and echolalia (Jankovic 1992 ; Jankovic and Stone 1991 ; Jankovic 2001 ) . Facial tics
are treated with reassurance, and BoNT injections are hardly ever recommended.
16.12 Summary
Various movement disorders cause involuntary or rarely voluntary contractions of
the facial muscles and subsequently lead to both esthetic and functional problems.
Although symptomatic therapy including BoNT injection is available, better
approaches are needed and will likely become available as the understanding of the
genetics and pathophysiology improves.
References
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sensitivity in benign essential blepharospasm. Am J Ophthalmol 142(1):82–87
Adler CH, Zimmerman RA, Savino PJ, Bernardi B, Bosley TM, Sergott RC (1992) Hemifacial
spasm: evaluation by magnetic resonance imaging and magnetic resonance tomographic
angiography. Ann Neurol 32(4):502–506
Ainsworth JR, Kraft SP (1995) Long-term changes in duration of relief with botulinum toxin treatment
of essential blepharospasm and hemifacial spasm. Ophthalmology 102(12):2036–2040
Alappan N, Shyam Sundar A, Varghese ST (Spring 2008) Neuroleptic induced laryngo-pharyngeal
dystonia. J Neuropsychiatry Clin Neurosci 20(2):241–242
Albanese A (2011) Terminology for preparations of botulinum neurotoxins: what a difference a
name makes. JAMA 305(1):89–90