From the Guidelines
Facial dyskinesia treatment should prioritize addressing the underlying cause and using medications to manage symptoms, with a focus on reducing morbidity, mortality, and improving quality of life. For tardive dyskinesia, which is often caused by long-term use of antipsychotic medications, the first step is to reduce or discontinue the offending medication if possible, as recommended by the American Psychiatric Association 1. FDA-approved medications specifically for tardive dyskinesia include valbenazine (Ingrezza) at 40-80mg once daily and deutetrabenazine (Austedo) at 6-48mg daily in divided doses. These VMAT2 inhibitors work by reducing dopamine release in the brain, helping to control abnormal movements.
Key Considerations
- For drug-induced parkinsonism, anticholinergic medications like benztropine (1-2mg twice daily) or trihexyphenidyl (2-5mg three times daily) may be helpful, as suggested by the American Psychiatric Association 1.
- Amantadine (100mg twice daily) can also be effective for various forms of dyskinesia.
- For hemifacial spasm or blepharospasm, botulinum toxin injections administered every 3-4 months directly into affected muscles provide targeted relief by blocking nerve signals.
- In severe cases unresponsive to medication, deep brain stimulation surgery might be considered.
Treatment Approach
Treatment should be individualized based on the specific type of dyskinesia, its cause, and the patient's overall health status. Regular follow-up is essential to monitor effectiveness and adjust treatment as needed. The American Psychiatric Association recommends that patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments 1.
Patient-Centered Care
Patient preference and quality of life should be considered in the treatment decision-making process. Patients with facial paralysis may experience psychosocial dysfunction and diminished quality of life, and may benefit from support or counseling to deal with the emotional and physical consequences of persistent facial paresis/paralysis, as noted in the clinical practice guideline for Bell's palsy 1.
From the Research
Treatment Options for Facial Dyskinesia
- Botulinum toxin injections have been shown to be effective in treating facial dyskinesias, including blepharospasm and synkinesis 2, 3, 4.
- In some cases, discontinuing the medication that may be causing the facial dyskinesia can lead to improvement in symptoms 2.
- Facial neuromuscular retraining and biofeedback have also been used to treat facial synkinesis 3.
- Surgical therapies, such as selective neurolysis or myectomy, may be considered in severe cases of synkinesis 3, 5.
- A multidisciplinary approach, involving therapists, clinicians, and surgeons, is necessary to develop a comprehensive treatment regimen for facial dyskinesia 5.
Types of Facial Dyskinesia
- Blepharospasm: a type of facial dyskinesia characterized by involuntary eyelid spasms 2.
- Synkinesis: a type of facial dyskinesia characterized by abnormal involuntary facial movements that accompany volitional facial movements 3, 4, 5.
- Chorea, dystonia, tremor, and tics are other types of facial dyskinesias that have been described 6.
Evaluation and Diagnosis
- Evaluation of facial dyskinesia is primarily subjective, using facial grading scales such as the Sunnybrook scale 3, 4.
- Objective measures of synkinesis using computerized video analysis show promise, but are not widely used 3.
- A thorough understanding of facial mimetic musculature is imperative in guiding appropriate intervention for facial dyskinesia 5.