Symptoms of multiple sclerosis of the face
It can start with something we all know: tiny spasms around the eyelid.
“When you’re tired or stressed and you have butterflies under your eye or eyelid and it’s really annoying,” says Sharon Stoll, DO, neurologist and MS specialist at Yale Medicine. And for most people, that’s as far as it goes.
But when that tic comes from multiple sclerosis (MS), these facial twitches can spread. It could go down your cheek to your mouth or jaw. And it happens more often. “It happens several times a day,” says Oliver Tobin, MB, an MS neurologist at Mayo Clinic.
Usually, MS facial twitches affect one side of your face at a time. And you may notice other facial symptoms first, like numbness, tingling, weakness, or other strange sensations.
“People usually say, ‘My face is swollen, but I look in the mirror and it’s not swollen,'” Stoll says. “And the spasms will occur months later.”
Different Types of MS Facial Spasms
Even for people with MS, an occasional twitching of the eyelids, by itself, usually has nothing to do with the disease. But in some cases, it can be a sign of a bigger MS-related problem, including:
Continuous facial myokymia: It may look like an eyelid tic (myokymia). But you will have continuous spasms in other areas, such as the forehead, cheeks, mouth, and chin.
These tightnesses are relatively common in people with MS. And they are usually short-lived and painless. But they can be uncomfortable. “It’s just weird,” Tobin says.
Hemifacial spasm: Compared to facial myokymia, these are contractions of longer duration.
Strong facial spasms can force your eyelid shut or pull your mouth to one side. You can feel a lot of tightness, Tobin says. At some point, all the muscles on one side of your face can be involved. It may seem like you have a seizure.
It is rare for MS to cause hemifacial spasm. Stoll hardly ever sees this in his practice. But if it happens to you, it tends to be more serious and life-limiting than facial myokymia.
“Imagine if half of your face spasms all the time,” she says. “You can’t eat. You can not speak.
What causes facial twitching in MS?
When you have MS, your immune system fails myelin. It is the protective covering around your nerves. Without this isolation, it’s difficult for signals to travel from your brain to your muscles as they should.
Most people with MS facial spasms have a lesion in a certain part of the brainstem called the pons. Important nerves enter and leave this bony canal. Doctors usually find damage to the seventh cranial nerve, better known as the facial nerve.
As the name suggests, your facial nerve controls your facial muscles. (It also plays a role in how some of your taste buds work.)
It is unclear exactly how MS lesions cause facial twitching. We need more research to find out. But scientists have a few theories, including:
Ehaptic transmission: Nerve impulses tell your body how to move. But a lack of myelin can make your nerves glitchy. And when you have two damaged (demyelinated) nerves next to each other, the electrical signal from one can trigger the other.
“It’s basically like a leaky current,” Tobin says.
Here are some examples of ephaptic transmission that you may be familiar with:
- Lhermittesign : You bend your neck and feel a buzzing sensation along your body. It can be a sign of MS, but it can happen to anyone.
- Tonic spasms: You will stand up or move your body and you feel painful muscle contractions in your arms or legs. These spasms usually last 60 to 90 seconds.
Nervous hyperexcitability: Your facial nerve may be pulling more than it should. Some scientists believe that hyperexcitability in other areas may cause MS facial twitching even if you don’t have a visible lesion in the pons of your face. your brain stem.
How do you diagnose facial twitching in MS?
unlike others MS symptomscontinued facial myokymia and hemifacial spasm may not be indicative of a new lesion.
Still, your doctor will want new images of your brain to be sure. Updated MRI scans can give strong clues as to whether your MS is well controlled or if you are relapsing.
You can also get a special nerve test. It’s called a electromyography (EMG). It will measure the timing of your muscle spasms. This is a good way to tell the difference between facial myokymia (short spasms) and hemifacial spasm (prolonged spasms).
Your doctor may order additional blood work or tests to rule out other health problems. You can have facial twitching for many reasons unrelated to MS, including inflammation or infection.
Your facial twitches could be idiopathic. This means “there is no real connection” to a medical condition, Stoll says.
Treatment of multiple sclerosis of the face
You may have nothing to do but wait. Facial twitching often goes away on its own after a few weeks or months. This is especially true for facial myokymia, Tobin says.
MS-related hemifacial spasm also tends to subside over time. But it can take years. And some people can have these spasms for the rest of their lives.
The good news is that you can get help for your symptoms, no matter how long they last.
Treatment for facial twitching in MS includes:
botox: Botulinum toxin can temporarily paralyze facial muscles. This is how it gets rid of wrinkles. But it’s also the most effective way to stop severe facial twitching.
Botox can help people with hemifacial spasms “get their lives back,” Stoll says.
You will usually need injections every 3 months until your spasms stop. Ask your doctor to refer you to a neurologist who regularly treats hemifacial spasms. They will help you determine when it is safe to start and stop treatment.
Other medications: Your doctor may ask you to try other drug treatments. For mild facial twitches, this may include
Lifestyle changes: MS facial twitching is not your fault. “But it’s more likely to come back with stress and fatigue,” says Stoll.
When to see your doctor
Random eyelid twitches are usually nothing to worry about.
But check with your neurologist if other facial muscles begin to spasm. Call them immediately if your shaking is new and lasts longer than 24 hours. “That’s true for any symptom of multiple sclerosis,” Stoll says.
Facial twitching in MS usually goes away at some point. And when that happens, you might wonder: will he come back?
“That’s a good question. I don’t think we really know,” Tobin says. “But if it’s been gone for a week or two, then it’s probably gone.”