Facial Twitching and Multiple Sclerosis

Symptoms of MS Facial Twitching

It might begin as one thing we’re all conversant in: tiny spasms round your eyelid.

“When you’re tired or stressed and you get fluttering under your eye or eyelid and it’s really annoying,” says Sharon Stoll, DO, a neurologist and MS specialist with Yale Medicine. And for most individuals, that’s so far as it goes.

But when this twitching is from a number of sclerosis (MS), this facial twitching might unfold. It may go down your cheek to your mouth or jawline. And it occurs extra usually. “It’s occurring multiple times a day,” says Oliver Tobin, MB, a neurologist who makes a speciality of MS on the Mayo Clinic.

Usually, MS facial twitching impacts one aspect of your face at a time. And chances are you’ll discover different facial signs first, like numbness, tingling, weak spot, or different bizarre sensations.

“People will usually say, ‘My face feels swollen, but I look in the mirror and it’s not swollen,’” Stoll says. “And the spasms will happen months later.”

Different Types of MS Facial Twitching

Even for individuals who have MS, an occasional eyelid tremble, by itself, often has nothing to do with the illness. But in some instances, it could be an indication of a bigger subject associated to MS, together with:

Continuous facial myokymia: This can really feel sort of like an eyelid twitch (myokymia). But you’ll get ongoing spasms in different areas, similar to your brow, cheek, mouth, and chin.

These twinges are comparatively frequent in individuals who have MS. And they’re often short-lived and painless. But they are often uncomfortable. “It just feels weird,” Tobin says.

Hemifacial spasm: Compared to facial myokymia, these are longer-lasting contractions.

Strong facial spasms might pressure your eyelid closed or pull your mouth to 1 aspect. You might really feel numerous tightness, Tobin says. At some level, all of the muscle tissue on one aspect of your face could also be concerned. It might seem like you’re having a seizure.

It’s uncommon for MS to trigger hemifacial spasm. Stoll rarely sees it in her apply. But if it occurs to you, it tends to be extra extreme and lifestyle-limiting than facial myokymia.

“Imagine if half your face is spasming all the time,” she says. “You can’t eat. You can’t talk.”

What Causes MS Facial Twitching?

When you will have MS, your immune system breaks down myelin. That’s the protecting cowl round your nerves. Without this insulation, it’s laborious for alerts to journey out of your mind to your muscle tissue the way in which they need to.

Most folks with MS facial twitching have a lesion in a sure a part of the brainstem referred to as the pons. Important nerves go out and in of this bony canal. Doctors usually discover harm to the seventh cranial nerve, higher generally known as the facial nerve.

Like the title suggests, your facial nerve controls your facial muscle tissue. (It additionally performs a component in how a few of your style buds work.)

It’s unclear precisely how MS lesions trigger facial twitching. We want extra analysis to seek out out. But scientists have some theories, together with:

Ephaptic transmission: Nerve impulses inform your physique learn how to transfer. But an absence of myelin could make your nerves glitchy. And when you will have two broken (demyelinated) nerves proper subsequent to one another, {the electrical} sign from one can set off the opposite.

“It’s essentially like a leaky current,” Tobin says.

Here are some examples of ephaptic transmission that you simply could be conversant in:

• Lhermitte’s signal: You bend your neck and get a buzzing sensation down your physique. It could also be an indication of MS, however it will probably occur to anybody.
• Tonic spasms: You go to face or transfer your physique and get painful muscle contractions in your arms or legs. These spasms often final 60 to 90 seconds.

Nerve hyperexcitability: Your facial nerve might hearth greater than it ought to. Some scientists assume hyperexcitability from different areas might trigger MS facial twitching even for those who don’t have a visual lesion within the pons of your mind stem.

How Do You Diagnose MS Facial Twitching?

Unlike different MS signs, steady facial myokymia and hemifacial spasm might not be an indication of a brand new lesion.

Still, your physician will need some new photos of your mind to make certain. Updated MRI scans may give sturdy clues about whether or not your MS is well-controlled otherwise you’re having a relapse.

You might also get a particular nerve take a look at. This is named an electromyography (EMG). It’ll measure the timing of your muscle spasms. This is an effective option to inform the distinction between facial myokymia (brief spasms) and hemifacial spasm (extended spasms).

Your physician might order blood work or extra assessments to rule out different well being circumstances. You can have facial twitching for a lot of causes unrelated to MS, together with irritation or an infection.

Your facial twitches could be idiopathic. That means “there’s no real connection” to any medical subject, Stoll says.

Treatment for MS Facial Twitching

You might not have to do something besides wait. Facial twitching usually resolves by itself after a number of weeks or months. That’s very true for facial myokymia, Tobin says.

MS-related hemifacial spasm additionally tends to ease over time. But it might take years. And some folks might have these spasms for the remainder of their life.

The excellent news is you may get assist on your signs regardless of how brief or lengthy they final.

Treatment for MS facial twitching contains:

Botox: Botulinum toxin can quickly paralyze facial muscle tissue. That’s the way it removes wrinkles. But it’s additionally the best option to cease critical facial twitches.

Botox may also help folks with hemifacial spasm “get their lives back,” Stoll says.

You’ll usually want pictures each 3 months till your spasms cease. Ask your physician to refer you to a neurologist who commonly treats hemifacial spasm. They’ll assist you determine when it’s secure to start out and cease remedy.

Other medicines: Your physician might have you ever strive different drug remedies. For delicate facial twitching, which may embody

Lifestyle adjustments: MS facial twitching isn’t your fault. “But it’s more likely to reappear with stress and fatigue,” Stoll says.

When to See Your Doctor

Random eyelid twitches are often nothing to fret about.

But examine in along with your neurologist if different facial muscle tissue begin to spasm. Call them immediately in case your twitches are new and final for greater than 24 hours. “That’s true for any symptom from multiple sclerosis,” Stoll says.

MS facial twitching often goes away sooner or later. And when that occurs, chances are you’ll surprise: Will it come again?

“That’s a good question. I don’t think we really know,” Tobin says. “But if it’s gone for a week or two, then it’s probably gone.”