Movement Disorders of the Face

  • Mónica M. KurtisEmail author


Movement disorders of the face are frequent; they can be hypokinetic or hyperkinetic, primary or secondary, and be manifestations of an isolated condition or part of a generalized disorder. Hypokinetic movements such as hypomimia are characteristic of parkinsonian syndromes, while facial hyperkinetic movements are very common in certain forms of dystonia, dyskinesias, chorea, myoclonus, tremor, tics, and psychogenic movement disorders. Since these topics are covered extensively in other parts of the text, this chapter focuses on the clinical characteristics of movement disorders (centering on primary etiologies) when they affect the facial muscles and covers other entities that fall into the differential diagnosis. Emphasis is made on phenomenology with careful description of clinical signs and distinguishing features that may aid the diagnosis.


Hypomimia Blepharospasm Eyelid apraxia Oro-buccal dystonia Oro-buccolingual dyskinesias Chorea Facial myoclonus Chin tremor Psychogenic facial movement disorders 

Supplementary material

Video 39.1

Tardive oro-buccal lingual dyskinesias and craniocervical dystonia. Note the stereotypical lip puckering, grimacing, and tongue protrusion movements. She shows jaw-opening dystonia with mandibular deviation to the right and blepharospasm. You can hear the laryngeal stridor that interrupts her speech (MP4 12646 kb)

Video 39.2

Facial tics. The young woman shows brief, rapid, repetitive left depressor anguli oris and platysma contractions, as well as increased blinking that increase when she talks. When asked to be quiet, the movements improve, almost disappearing. When she relaxes, the tics reappear. She explains that she can control the tics to a certain extent with a lot of concentration. She demonstrates the lower facial tics that also appear less often on the contralateral side (MP4 3734 kb)

Video 39.3

Edentulous dyskinesias. Patient with loose dentures showing jaw deviation and jaw-closing stereotypic movement. He is explaining that he tends to remove the denture with his finger, as a habit. After removing the upper dentures, the movements almost completely disappear (MP4 46790 kb)


  1. 1.
    Penfield W, Rasmussen T. The cerebral cortex of man. New York: Macamillan. 1950Google Scholar
  2. 2.
    Avivi-Arber L, Martin R, Lee JC, Sessle BJ. Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol. 2011;56(12):1440–65.CrossRefPubMedGoogle Scholar
  3. 3.
    Bologna M, Fabbrini G, Marsili L, Defazio G, Thompson PD, Berardelli A. Facial bradykinesia. J Neurol Neurosurg Psychiatry. 2013;84(6):681–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, et al. Voluntary, spontaneous, and reflex blinking in Parkinson’s disease. Mov Disord. 2008;23(5):669–75.CrossRefPubMedGoogle Scholar
  5. 5.
    Bologna M, Agostino R, Gregori B, Belvisi D, Ottaviani D, Colosimo C, et al. Voluntary, spontaneous and reflex blinking in patients with clinically probable progressive supranuclear palsy. Brain. 2009;132(Pt 2):502–10.PubMedGoogle Scholar
  6. 6.
    Ozekmekci S, Benbir G, Ozdogan FY, Ertan S, Kiziltan ME. Hemihypomimia, a rare persistent sign in Parkinson’s disease: follow up of 11 patients. J Neurol. 2007;254(3):347–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Crosiers D, Marechal E, van Ael Y, Cras P. Left-sided hemihypomimia in Parkinson’s disease. Acta Neurol Belg. 2011;111(3):225–7.PubMedGoogle Scholar
  8. 8.
    De Cock VC, Vidailhet M, Leu S, Texeira A, Apartis E, Elbaz A, et al. Restoration of normal motor control in Parkinson’s disease during REM sleep. Brain. 2007;130(Pt 2):450–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Romano S, Colosimo C. Procerus sign in progressive supranuclear palsy. Neurology. 2001;57(10):1928.CrossRefPubMedGoogle Scholar
  10. 10.
    Fabbrini G, Defazio G, Colosimo C, Thompson PD, Berardelli A. Cranial movement disorders: clinical features, pathophysiology, differential diagnosis and treatment. Nat Clin Pract Neurol. 2009;5(2):93–105.CrossRefPubMedGoogle Scholar
  11. 11.
    Ross AH, Elston JS, Marion MH, Malhotra R. Review and update of involuntary facial movement disorders presenting in the ophthalmological setting. Surv Ophthalmol. 2011;56(1):54–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Jankovic J, Orman J. Blepharospasm: demographic and clinical survey of 250 patients. Ann Ophthalmol. 1984;16(4):371–6.PubMedGoogle Scholar
  13. 13.
    Defazio G, Livrea P, De Salvia R, Manobianca G, Coviello V, Anaclerio D, et al. Prevalence of primary blepharospasm in a community of Puglia region. Southern Italy Neurol. 2001;56(11):1579–81.Google Scholar
  14. 14.
    Zadikoff C, Lang AE. Apraxia in movement disorders. Brain. 2005;128(Pt 7):1480–97.CrossRefPubMedGoogle Scholar
  15. 15.
    Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med. 2003;349(20):1925–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Elston JS. A new variant of blepharospasm. J Neurol Neurosurg Psychiatry. 1992;55(5):369–71.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Forget R, Tozlovanu V, Iancu A, Boghen D. Botulinum toxin improves lid opening delays in blepharospasm-associated apraxia of lid opening. Neurology. 2002;58(12):1843–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Hallett M, Albanese A, Dressler D, Segal KR, Simpson DM, Truong D, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of movement disorders. Toxicon. 2013;67:94–114.CrossRefPubMedGoogle Scholar
  19. 19.
    Abbruzzese G, Berardelli A, Girlanda P, Marchese R, Martino D, Morgante F, et al. Long-term assessment of the risk of spread in primary late-onset focal dystonia. J Neurol Neurosurg Psychiatry. 2008;79(4):392–6.CrossRefPubMedGoogle Scholar
  20. 20.
    LeDoux MS. Meige syndrome: what’s in a name? Parkinsonism Relat Disord. 2009;15(7):483–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Balint B, Bhatia KP. Dystonia: an update on phenomenology, classification, pathogenesis and treatment. Curr Opin Neurol. 2014;27(4):468–76.CrossRefPubMedGoogle Scholar
  22. 22.
    Luquin MR, Scipioni O, Vaamonde J, Gershanik O, Obeso JA. Levodopa-induced dyskinesias in Parkinson’s disease: clinical and pharmacological classification. Mov Disord. 1992;7(2):117–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Wenning GK, Colosimo C, Geser F, Poewe W. Multiple system atrophy. Lancet Neurol. 2004;3(2):93–103.CrossRefPubMedGoogle Scholar
  24. 24.
    Lehn A, Boyle R, Brown H, Airey C, Mellick G. Neuroferritinopathy. Parkinsonism Relat Disord. 2012;18(8):909–15.CrossRefPubMedGoogle Scholar
  25. 25.
    Jankovic J, Gelineau-Kattner R, Davidson A. Tourette’s syndrome in adults. Mov Disord. 2010;25(13):2171–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Berardelli A, Curra A, Fabbrini G, Gilio F, Manfredi M. Pathophysiology of tics and Tourette syndrome. J Neurol. 2003;250(7):781–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Brown P. Neurophysiology of the startle syndrome and hyperekplexia. Adv Neurol. 2002;89:153–9.PubMedGoogle Scholar
  28. 28.
    Andermann F, Andermann E. Startle disorders of man: hyperekplexia, jumping and startle epilepsy. Brain Dev. 1988;10(4):213–22.CrossRefPubMedGoogle Scholar
  29. 29.
    Nielsen VK. Electrophysiology of the facial nerve in hemifacial spasm: ectopic/ephaptic excitation. Muscle Nerve. 1985;8(7):545–55.CrossRefPubMedGoogle Scholar
  30. 30.
    Stamey W, Jankovic J. The other Babinski sign in hemifacial spasm. Neurology. 2007;69(4):402–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Danek A. Geniospasm: hereditary chin trembling. Mov Disord. 1993;8(3):335–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Devetag Chalaupka F, Bartholini F, Mandich G, Turro M. Two new families with hereditary essential chin myoclonus: clinical features, neurophysiological findings and treatment. Neurol Sci. 2006;27(2):97–103.CrossRefPubMedGoogle Scholar
  33. 33.
    Silverdale MA, Schneider SA, Bhatia KP, Lang AE. The spectrum of orolingual tremor – a proposed classification system. Mov Disord. 2008;23(2):159–67.CrossRefPubMedGoogle Scholar
  34. 34.
    Fasano A, Valadas A, Bhatia KP, Prashanth LK, Lang AE, Munhoz RP, et al. Psychogenic facial movement disorders: clinical features and associated conditions. Mov Disord. 2012;27(12):1544–51.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol. 2011;69(5):892–900.CrossRefPubMedGoogle Scholar
  36. 36.
    Striano P. Faciobrachial dystonic attacks: seizures or movement disorder? Ann Neurol. 2011;70(1):179–80.Google Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.Movement Disorders Unit, Department of NeurologyHospital Ruber InternacionalMadridSpain

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