Violent facial expressions are contractions of certain muscles of the face that are not amenable to conscious control. It is more often caused by neurological pathologies: facial hemispasm, idiopathic blepharospasm, oromandibular dystonia, Huntington's chorea, multisystem atrophy, tics, tardive dyskinesia while taking antipsychotics. It is observed in some ophthalmic diseases and mental disorders. The cause is established on the basis of complaints, anamnesis, neurological examination data and additional diagnostic procedures. Treatment - botulinum therapy, muscle relaxants, neuroleptics, sometimes surgical interventions.
Violent facial expressions are involuntary movements of certain muscles or entire muscle groups. They are more common in neurological problems. May cover half of the face (hemispasm) or be symmetrical. In the second case, in the initial stages, there is a predominant involvement of the muscles of the eyelids or lower parts of the face. With progression, hyperkinesis often spreads to other muscle groups of the facial region, sometimes to the neck, shoulder girdle, and other areas. In ophthalmic diseases, the symptom has a reflex character, due to swelling and pain.
It becomes a consequence of irritation of the central parts of the facial nerve. The defeat is one-sided. A typical paroxysm begins with repeated closing of the eyelid. Movements become more frequent, spread to the entire half of the face. With an atypical course, the buccal muscles contract first, then the muscles of the forehead, lips and periorbital region are involved in the process. The duration of the attack is 1-3 minutes. The number of episodes can reach 10 or more per day.
Facial hemispasm differs from other variants of violent mimic movements of neurological origin by the inability to consciously demonstrate the phenomenon, the absence of paradoxical kinesias and corrective gestures. The provocative factors of unusual facial expressions are:
It is considered a type of cranial muscular dystonia, develops in the second half of life. Symmetric. The main symptom of idiopathic blepharospasm is involuntary squinting of the eyes, which eventually turns into persistent spasms that persist for 3-5 minutes. Involuntary facial expressions also cover the lower part of the face and neck. Typical corrective gestures, stopping the attack when sucking sweets, smoking, expressive speech, strong emotions, drinking alcohol, closing the eyes.
Occurs with organic cerebral pathologies. As with the idiopathic form, facial expressions become less pronounced when using corrective gestures, emotional arousal, and oral activity. May accompany the following diseases:
A list of other pathological conditions in which secondary blepharospasm may occur includes ischemic strokes in the thalamus and left frontal lobe, Arnold-Chiari malformation, and hepatolenticular degeneration. Sometimes the symptom is provoked by prolonged use of antiparkinsonian drugs and antidepressants.
Violent facial expressions are found mainly in the mouth area, covering the lips, the lower jaw area, and the tongue. The most common variant is tardive dyskinesia, a type of neuroleptic syndrome that develops with long-term medication. Patients lick their lips, make chewing and sucking movements, smack their lips, stick out their tongue, and make faces.
With oromandibular dystonia, not only the muscles of the oral zone are involved in the process, but also the cheeks, chewing, and sometimes the cervical and respiratory muscles. Violent motor acts include clenching of the jaws, jaw movements from side to side, opening and closing of the mouth, curvature of the lips, involuntary smile, twitching of the cheeks. Patients actively use corrective gestures.
Along with the above diseases, violent facial expressions are observed in the following conditions:
Violent movements of the eyelids in ophthalmic diseases are easy to differentiate from dystonia, due to a clear connection with symptoms from the organ of vision, the absence of corrective gestures and paradoxical kinesias. The causes of blepharospasm are:
Elements of involuntary facial expressions can be observed in schizophrenia. A proboscis smile indicates a functional lesion of the corticonuclear level, indicating probable intoxication with antipsychotics. A forced smile occurs with coldness and emotional impoverishment, is an imitation or is aimed at eliminating communication difficulties, is combined with hypomimia.
Briquet's syndrome is characterized by a pronounced variety of manifestations. One of the rare variants of the course are hyperkinesis, including violent facial expressions with a predominance of blepharospasm and the development of eyelid paralysis. Perhaps a combination with paresis and paralysis of the limbs, astasia-abasia, gait disturbances, seizures, and other movement disorders.
Determining the cause of violent facial expressions in most cases is the responsibility of neurologists. Patients with eye involvement are examined by ophthalmologists. If you suspect a mental pathology, a psychiatric consultation is required. As part of the conversation with the patient, the specialist establishes when the symptom appeared, how it changed over time, what other manifestations it was accompanied by. The examination program may include such diagnostic manipulations as:
Schizophrenia is diagnosed when certain established criteria are met. Briquet's syndrome is detected on the basis of the medical history, complaints, and the results of an objective examination, indicating the polymorphism of clinical manifestations when they do not correspond to neurological and somatic pathologies.
Introduction of botulinum toxin
Treatment tactics are chosen taking into account the etiology of violent facial expressions:
In diseases accompanied by violent facial expressions, the following surgical interventions are performed: