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Multiple sclerosis MS is a chronic inflammatory demyelinating disease of the central nervous system. The etiology is insufficiently understood. Autoimmune, genetic, viral, and environmental factors have been hypothesized. MS is twice as common in women as in men between the ages of 20 and 50 years. There is no known cure for MS. Current medical treatment helps to prevent new attacks and improve function after an attack.
MS is diagnosed by physical examination, diagnostic imaging, and examination of cerebral spinal fluid. The most common physical signs and symptoms of MS include constitutional symptoms, muscle weakness, motor and autonomic spinal cord symptoms, paresthesias, and vision changes. Here we present a case of MS diagnosed in a year-old male with facial myokymia of left eyelid, which progressed to left hemifacial spasm. This is an unusual presentation for multiple sclerosis.
An awareness of this presentation "Multiple sclerosis facial" only may lead to an earlier diagnosis in some patients but can be a sign of relapse in patients with established multiple sclerosis. Most common causes are thought to be related to autoimmune, genetic, viral, and environmental factors. MS is twice as common in women as in men between the ages of
Multiple sclerosis facial years.
Multiple sclerosis facial diagnosed by physical examination, diagnostic testing including imaging, and examination of cerebral spinal fluid. A year-old male presents with several weeks of what he described as spasms of his left eyelid which progressed to episodes of twitching of his left eye and left cheek. A comprehensive review of systems was negative. He denied history of tobacco, drug, or alcohol abuse. His past medical history included gastroesophageal reflux disease and osteogenesis imperfecta.
His past surgical history and family history were noncontributory. He did not take any prescribed, herbal, or over the counter medications.
He drank one to two cups of coffee daily. His vital signs were within normal limits. His vital signs were normal on presentation. He was orientated to person, place, and time and well-developed, well nourished, and in no distress. Spasms were noted of his left eyelid with brief episodes of left hemifacial spasm. His physical exam was otherwise within normal limits.
Diagnostic testing included magnetic resonance imaging MRI of the brain, magnetic resonance angiogram MRA
Multiple sclerosis facial the head and neck, complete blood count with differential, comprehensive metabolic panel, magnesium, phosphorus, thyroid stimulating hormone, free thyroxine, lipid panel, and an erythrocyte sedimentation rate ESR. The MRA showed no evidence of a hemodynamically significant intracranial stenosis, occlusion, or aneurysm.
An MRI of the brain was performed at 3T with the following sequences: The MRI showed T2-weighted lesions. There was a round focus of hyperintense signal within the left anterior Multiple sclerosis facial measuring up to six millimeters.
There was a hyperintense signal within the right parasagittal pons. There was a dominant focus of hyperintense signal lateral to the right atrium extending to the right posterior medial temporal lobe measuring up to 18 millimeters. There was a round focus of hyperintense signal within the left inferior frontal subcortical white matter.
Additional foci of hyperintense signal were seen within the right and left periatrial white matter as well as within the bilateral corona radiata and centrum semiovale. The findings were interpreted as consistent with multiple sclerosis. The patient was referred to Neurology. A diagnosis of multiple sclerosis was made. It was felt by Neurology that the location of the lesions would be consistent with his symptoms. The patient has been followed by Neurology and has been doing well with the current treatment in the six months following the diagnosis.
He was not treated with botulinum toxin. He was not treated with corticosteroids. Myokymia is defined as muscle twitching of the nature of undulating vermicular muscle movements under the skin without contractures that move the face [ 1 ].
It may progress to facial contractures, which can be sustained. Myokymia, with or without progression to facial intermittent spasm, and with or without sustained contractures, is said in the literature to be an uncommon presentation of multiple sclerosis. It can sometimes be seen during a relapse [ 2 ].
The etiology is unclear but hyperexcitability of the facial neurons secondary to demyelination of corticospinal tract fibers is proposed [ 3 ]. Spastic contractures of facial muscles associated with multiple sclerosis can be nonsustained. When nonsustained, such contractures have been called hemifacial spasm HFS in the literature. Sustained contractures have Multiple sclerosis facial called spastic paretic hemifacial contracture SPHC.
The difference in the EMG findings appears to be whether individual muscles or groups of muscles are involved myokymia and whether the firing is nonsustained HFS or sustained SPHC [ 2 — 4 ].
Facial "Multiple sclerosis facial" and facial spasms in the context of multiple sclerosis been treated with botulinum toxin injections [ 5 ].
In a case series of twelve patients with MS and facial myokymia, Jacobs et al. MRI is utilized today as a marker in treatment response. In a patient undergoing immunomodulatory or immunosuppressive treatment for relapsing-remitting MS, myokymia might correspond to a MS relapse, indicating disease activity despite actual therapy, so optimizing therapy might be considered.
It could also be suggested that myokymia may prompt consideration of MS as a new diagnosis, as in this case. Transient facial myokymia can be due to such benign causes as fatigue, excessive caffeine, anxiety, eye muscle fatigue, and mild magnesium deficiency. Stress and dehydration can be associated. Progressive SPHC has been seen in brainstem tumors [ 23 ]. HFS has been seen in vertebral aneurysm and with enlarged vertebrobasilar vessels. It has been seen with enlarged anomalous vessels that compress the seventh nerve at the level of the brainstem, as well as with cholesteatomas and acoustic neuromas [ 4 ].
Here we present an unusual presentation of multiple sclerosis diagnosed in a year-old male with facial myokymia of left eyelid, which progressed to left hemifacial spasm.
Myokymia, with or without progression to facial intermittent spasm, and with or without sustained contractures, is said in the literature to be an uncommon presentation of multiple sclerosis but could be suggestive of a relapse [ 2 ]. An awareness of this presentation may lead to a diagnosis of MS in some patients and can be a sign of relapse in patients with established multiple sclerosis. Case Reports in Neurological Medicine. Indexed in Web of Science. Subscribe to Table of Contents Alerts.
Table of Contents Alerts. Abstract Multiple sclerosis MS is a chronic inflammatory demyelinating disease of the central nervous system. Introduction Multiple sclerosis MS is a chronic inflammatory demyelinating disease of the central nervous system. The Case A year-old male presents with several weeks of what he described as spasms of his left eyelid which progressed to episodes of twitching of his
Multiple sclerosis facial eye and left cheek.
He was started on Copaxone glatiramer acetate as well as Vitamin D supplementation. Facial
Multiple sclerosis facial has also been described in the recovery phase of Guillain-Barre syndrome.
Conclusions Here we present an unusual presentation of multiple sclerosis diagnosed in a year-old male with facial myokymia of left eyelid, which progressed to left hemifacial spasm. Conflicts of Interest The authors declare that they have no conflicts of interest. Multiple Sclerosis is a disease of the central nervous which can affect many parts of the body. Why's it got to choose my face?.
Keywords: Multiple sclerosisIsolated idiopathic peripheral facial palsyBell's palsy Seventh nerve palsyPeripheral demyelinating disease. Looking for information on Multiple Sclerosis Symptoms? Find out Facial muscle twitching and trigeminal neuralgia have Multiple sclerosis facial been reported in patients.