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Psychogenic Hemifacial Spasm

Received April 27, 2000; revised July 26, 2000; accepted July 31, 2000. From the Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX. Address correspondence to Dr. Jankovic, Parkinson's Disease and Movement Disorders Clinic, Baylor College of Medicine, Department of Neurology, 6550 Fannin, Smith 1801, Houston, TX 77030.

Facial spasms that distort facial expression are typically due to facial dystonia, tics, and hemifacial spasm (HFS). Psychogenic facial spasms, however, have not been well characterized. The authors sought to 1) determine prevalence of psychogenic facial spasm in patients referred for evaluation of HFS and 2) draw attention to clinical characteristics and potential diagnostic pitfalls. Among 210 consecutive patients referred for evaluation of HFS, 5 (2.4%) received diagnoses of psychogenic facial spasm. All patients were female; mean age was 34.6 years (range 26–45) and mean symptom duration 1.1 years (range 2 wk–2 yr). Onset was left-sided in 3 patients, and the lid was the initial site affected in 2 patients. This series of patients shows that facial spasms, although usually of neurovascular etiology, may be the initial or only manifestation of a psychogenic movement disorder, often associated with an underlying depression.

Key Words: Movement Disorders • Facial Spasm • Psychogenic Spasm

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