Fasciculation, Hemifacial Spasm, or something else?

[ccm]

I am a 32 yr. old male.  I am having visible spasms or twitches underneath my left eye.  This has lasted for the last 2.5 weeks.  The spasms usually occur every five to ten minutes or so and last only a few seconds.  Sometimes I'm fortunate enough to go 20 to 45 minutes between spams.  I've been told not to worry about this.  I didn't for the first week.  The second week I began to be concerned.  Into the third week, I'm now fairly depressed about this.  I'm a trial lawyer and its hard to get people to listen to what you are saying if the left side of your face is twitching.

Am I rightfully concerned about this and should I have it checked out, or should I continue to wait this out?  From the research that I've been able to do it seems like this is most likely some form of fasciculation, but if that was the case I would have thought it would have stopped by now.  Also, I don't consider myself particularly stessed or tired.

I also read that hemifacial spasms frequently begin under the left eye.  This is disconcerting.  I read botox is decreasingly effective over time to treat this and the thought of having this corrected by microvascular decompression (requiring a 2 inch hole in my skull) doesn't particularly appeal to me.

Finally, I live in the U.S. Virgin Islands, there is one neurologist and I'm not keen on him.  I'd gladly travel to Cleveland to get this checked out if you think its advisable.  Its an expensive venture for me, but this twitching is freaking me out and I'd really like it to stop.  What, if anything, do you think my problem is and what, if anything, do you think I should do about it.

[Suzlion]

A related discussion, Hemifacial spasm disappeared after 10 years! was started.

[re: Hemifacial spasms?]

I have been reading the entries about the hemifacial spasms.  About nine months ago, I had a constant twitching in my right eye.  After a week or so later, it began to move down my face, until finally reaching my mouth and chin.  After all that submided a week later, I had constant contractions of my face.  Whenever I drink, eat, talking, chew, purse my lips, etc, my right eye closes automatically.  I hid my symptoms for a long time until finally my husband and mother urged me to see a doctor.  I have had a CT scan, and scheduled for an MRI, and a neurology consult.  The closing of my eye always happens, the right side of my face has really bad days, and on good days, it feels like there's really strong duct tape going across my face.  Meaning, it feels like its constantly tensed up.  My family practioner said it could only be in my head.  I see the physical symptoms, I know they are happening.  The right side of my mouth draws up at times and I hide it from anyone who can see it.  

I would be very interested in what your neurologist says.  I'm concerned he will also tell me, its psychosomatic.  I'm 36 years old.

If anyone wants to contact me privately, please email me at:  ***@****.  

thanks.

[TAW]

CCM

I'm a 46 yr. old female, and I have had fasciculations of the
muscle under my right eye for almost 8 weeks now.  They had
been constant until 3 days ago, and now are intermittent.  I
have the "convenience" of being a nurse with access to many
doctors who all gave me different opinions.  Thankfully, a couple
of them were concerned enough about my symptoms to guide me to
seek the benefits of a neurologist.  I also have some rare pain
in the affected side of my head and some positional dizziness to
further concern me.  I have an appointment with the neuro doc
in another week or so, but his staff recommended an MRI of the
brain before my appointment.  I had that done yesterday, and it
was read as normal by the radiologist.  My husband insists that
I continue to check this out even though my symptoms have gotten
better(after taking a couple days of Tegretol that one of my
ER doc friends prescribed).  I only took it for a couple of days
because it only decreased the intensity of the contractions but
did not slow them down, and it was making me sleep about 12 hours
a day.  If you're interested in finding out what the neurologist
has to say about it when I go for my appointment, let me know.
I tried to post a question on this forum, but they have always
reached their limit.

[Norma L.]

In l983, a very elderly dentist, by his own admission, severed a nerve, probably trigeminal,he said, while giving me a shot of novacaine.  Paralysis was almost immediate.  He said it would go away.  I'm still waiting.  The opthamologists say "hemifacial spasm."  I had 15 acupressure treatments, 8 months of acupuncture, 3 sessions of botox injections, tegratol nearly killed me.  My twitching left eye and drawn mouth area have become my trademarks.  It begins around the left side of my mouth, not painful, just very very annoying.  I'm told my left eye is my good eye - I say why not -it's been shutdown since l983.  The only medication I've found which really helps, much to the chagrin of MDs is plain old aspirin every 3 waking hours.
This means I take on average 9 - 12 per day.  Now, they are given credit for bringing me through a major heart attack and keeping me going, including 3 minor surgeries.  My only other medication is 2.5 mg of Zebeta for blood pressure.  I do note that stressful events make the twitches worse, and cold weather is devastating.  The doctors have talked about the teflon pad surgery,with only a 60% or less chance of improvement.  I argue that at 77, Idon't relish being a guinea pig.  Is this a clonic situation as well as a hopeless one?

[CCF Neuro[P] MD, RPS]

Dear CCM:

Sorry that your having problems with your eye muscles.  It is always difficult to tell you exactly what is occurring.  Hemifacial spasm is a clonic spasm which is more of a quick muscle contraction that is usually rhythmic.  A fasciculation is more of a simple muscle contraction that may not be rhythmic but it may be more constant and irregular in contractions.  With hemifacial spasm, there is usually a burst of action potentials in the 5 to 20 per second range that can be seen on EMG.  One usually would like to rule out facial myokymia or rippling movements of the facial muscles (would be seen in GBS, brainstem tumors, or MS).  There is a CCF in Florida that might be an alternative to coming to Cleveland in the winter.  If the problem is hemifacial spasm, then epileptic medications such as tegratol or neurontin can be helpful in some patients.  If it is a simple case of benign fasciculation, then time will solve the problem.

Sincerely,

CCF Neuro MD