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      Hemimasticatory Spasm: Report of a Case and Review of the Literature†

      case-report

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          Abstract

          Background

          Hemimasticatory spasm is a very rare movement disorder characterized by unilateral, involuntary, paroxysmal contractions of the jaw-closing muscles, causing clinically brief twitches and/or spasms.

          Case Report

          A 62-year-old female consulted us with a 30-year history of unusual involuntary twitches in the preauricular region and spasms that hampered jaw opening. During these spasms, she could not open her mouth. On physical examination, we also observed hypertrophy of the masseter and temporalis muscles, which can be features of hemimasticatory spasm. She was treated with botulinum toxin type A, with excellent response. Here, we present her case and review the literature.

          Discussion

          Hemimasticatory spasm is a rare movement disorder. Given the excellent response to botulinum toxin type A treatment, it should be considered within the spectrum of facial spasms.

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          Most cited references28

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          The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms.

          Joseph Jankovic, Toby Yaltho (2011)
          Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n=23, 11%), facial nerve injury (n=13, 6%), demyelination (n=2), and brain vascular insults (n=2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features. Copyright © 2011 Movement Disorder Society.
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            A Manual of Diseases of the Nervous System

            W. R. Gowers (1888)
            Article 0 comments Cited 48 times – based on 0 reviews     Review now
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              Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm.

              Alvimar G. Delgado, Aline J Gallego, Kurt C. Marsden … (1986)
              The clinical features, differential diagnosis and treatment of unilateral spasms of the jaw and masticatory muscles are discussed and illustrated by eight cases of unilateral jaw spasms of various aetiologies. These include focal dystonia of the jaw, hemimasticatory spasm with and without facial hemiatrophy, paroxysmal events in multiple sclerosis and tetany. Attention is particularly drawn to four cases of unilateral dystonia of the jaw which has not been described before.
              Article 0 comments Cited 18 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (iso-abbrev): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (publisher-id): TOHM
                Title: Tremor and Other Hyperkinetic Movements
                Publisher: Columbia University Libraries/Information Services
                ISSN (Electronic): 2160-8288
                Publication date Collection: 2014
                Publication date (Electronic): 4 April 2014
                Volume: 4
                Electronic Location Identifier: 210
                Affiliations
                [1 ]Instituto Argentino de Investigación Neurológica – IADIN, Buenos Aires, Argentina
                Columbia University, United States of America
                Author notes
                *To whom correspondence should be addressed. E-mail: corinachristie@ 123456yahoo.com.ar
                Article
                DOI: 10.7916/D8QF8QWD
                PMC ID: 3983676
                PubMed ID: 24757582
                SO-VID: 5e83260a-c296-4698-918d-04866d3872dc
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommerical–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original author and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.

                History
                Date received : 30 October 2013
                Date accepted : 27 February 2014
                Page count
                Pages: 6
                Categories
                Subject: Case Reports

                Keywords: hemimasticatory spasm,botulinum toxin,jaw-closing spasm
                Data availability:
                Keywords: hemimasticatory spasm, botulinum toxin, jaw-closing spasm

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