When does a facial tic mean I have blepharospasm?

The term "facial tic" is often used to describe involuntary, brief and not-sustained movements that involve the face, particularly those around the eyes and the corner of the mouth, and are usually not associated with the "squeezing" of the muscles around the eyes that typically accompanies blepharospasm.

The common facial tic includes the condition hemifacial spasm, a condition characterized by very rapid, abnormal contractions of one side of the face. Sometimes hemifacial spasm may follow Bell's palsy (a form of temporary facial paralysis resulting from damage or trauma to one of the two facial nerves) or be associated with facial weakness. Often the movements are provoked by eating, talking or whistling. Some patients experience symptoms in the upper areas of the face when they move the lower part of the face.

Another facial tic is the quick facial movements that occur in people who have chronic motor tics. Chronic motor tics may affect one or both sides of the face, and the movement is usually preceded by an urge to make the movements. After the movement is made, the urge is often relieved. People with chronic motor tics usually have the ability to suppress the movements if they concentrate on the movements. Chronic motor tics may involve any part of the body, including the face, arms, legs and trunk.

The manifestation of blepharospasm is an involuntary movement that involves the eyelid and brow muscles, and dystonia may also involve the lower face, tongue, pharynx, jaw, neck, or other body segments. However, these movements are usually not suppressible, because they are involuntary and not under the direct control of the person with them.

There is some overlap among how blepharospasm and tics appear, so that even experts may disagree on whether a patient has chronic motor tics or blepharospasm. Most of the disagreement will occur when the symptoms are subtle, and they present with similar findings on examination. Taking a history will sometimes clarify the cause. Hemifacial spasm and blepharospasm are known to have an excellent response to botulinum toxin treatment. Facial tics may respond, too.

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