Facial spasm

Adverse effects include drowsiness, diarrhoea, facial spasm, trismus, oculogyric crisis seen commonly in children and young adults. 

Liver-wind disturbance Epilepsy, severe case of hypertension and glaucoma, facial paralysis, facial spasms, cerebrovascular accident and its sequelae. 

Rheumatic arthritis, rheumatoid arthritis, cervical or lumbar spondylosis, osteoarthritis, sciatica, Raynaud s disease, vasculitis, pulmonary heart disease, rheumatic heart disease, coronary heart disease, migraine, hemiplegia after cerebrovascular accident, paralysis, facial paralysis, facial spasm, skin diseases that are influenced by changes in the weather and are characterized by itchy, weeping, red or dry skin lesions. 

Convulsions, severe facial spasms, and trismus occurred 7 hours after an infusion of ifosfamide in a dose of 7 g/m, having not occurred at a dose of 5 g/m, during a phase II study in patients with solid tumors (2). 

A 28-year-old female underwent an imcomplicated umbilical hernioplasty. The patient had a history of migraine but no other neurological or psychiatric disease. She received propofol 230 mg and fentanyl for induction of anaesthesia. The nature and dose of drugs used to maintain anaesthesia and given in the postoperative period and the anaesthetic technique employed are not provided. Six hours after surgery the patient was noted to have facial spasms, hand tremor, jerky neck... 

Trigeminal neuralgia pain and spasms along the trigeminal facial nerve... 

Blood pressure, heart rate, respiratory rate therapeutic response in patients with seizure disorder, a decrease in the frequency or intensity of seizures in patients with anxiety, a calm facial expression and decreased restlessness in patients with musculoskeletal spasm, decreased intensity of skeletal muscle pain... 

The therapeutic use of botulinum toxin for ophthalmic purposes and for local muscle spasm was mentioned in Chapter 6. Local facial injections of botulinum toxin are widely used for the short-term treatment (1-3 months per treatment) of wrinkles associated with aging around the eyes and mouth. Local injection of botulinum toxin has also become a useful treatment for generalized spastic disorders (eg, cerebral palsy). Most clinical studies to date have involved administration in one or two limbs, and the benefits appear to persist for weeks to several months after a single treatment. Most studies have used type A botulinum toxin, but type is also available. 

This formula can expel wind and phlegm, and thus relieve spasm. It is used when wind attacks the face where phlegm has accumulated. The wind stirs the phlegm, blocking the collaterals and causing spasm of muscles or facial paralysis. 

In clinical practice, it is used not only to treat facial paralysis and spasm, but also epilepsy due to wind and phlegm. 

Botulinum toxin A complexed with haemagglutinin is currently employed medicinally to counter involuntary facial muscle spasms, e.g. around the eye. Very small (nanogram) amounts are injected locally and result in the destruction of the acetylcholine release mechanism at the neuromuscular junction. Since new nerve junctions will gradually be formed over two months or so, the result is not permanent, and the treatment will need to be repeated. It has also been found useful in easing muscle spasticity in children with cerebral palsy. 

Meige s syndrome is characterized by blepharospasm and spasm of the lower facial or oromandibular muscles (395). 

Acute dystonia Spasm of tongue, throat, face, jaw, eyes, neck, or back muscles (torticollis, facial grimacing, oculogyric crises) 24 hours to <1 week... 

Unlike blepharospasm, the origins of hemifacial spasm are much better understood. Hemifecial spasm may occasionally be familial. In most instances, however, the spasm results from microvascular compression or irritation of the facial nerve by an aberrant artery of abnormal vasculature in the posterior fossa or from a cerebellopontine tumor. 

Adverse events in patients who receive botulinum toxin injections for hemifecial spasm are virtually identical to those that occur in treatment of BEB. However, diplopia and lower facial weakness are more common in patients with hemifacial spasm. 

Surgery for hemifecial spasm involves microvascular decompression of the fecial nerve by placement of a sponge under posterior fossa vessels (Jannetta procedure). Surgery for hemifecial spasm is associated with cure rates exceeding 80%, and beyond 2 years there appears to be little risk of relapse. However, surgical intervention can have serious complications such as permanent facial paralysis, deafness, stroke, and even death. 

Facial paralysis is occasionally reported and is not necessarily due to poor technique in one case vascular spasm seemed to provide an explanation (SED-12, 252). 

In high dose, injection of metoclopramide can cause sedation and facial muscle spasms due to effects on dopamine receptors in the brain. This is similar to the adverse reactions seen with antipsychotic drugs (see Chapter 11). 

A patient has been receiving abdominal radiotherapy for a period of time for the treatment of colon cancer. She has suffered quite serious nausea as a result of the treatment. You have supplied metoclopramide (in 28 packs of 10 mg tablets) to the patient on a regular basis under PGDs. The patient is now complaining that this drug does not seem to work any more. She has also been experiencing facial muscle spasms and wonders if this could be a side effect of her radiotherapy or the drug. In addition, the patient has developed a painful skin rash over the treatment area. 

Discuss this patient s case and consider whether you can suggest an alternative to metoclopramide and a suitable treatment for the skin rash. You should consider why the patient is experiencing facial muscle spasms and whether this... 

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