Visit previous version of website
FND Links Feedback Donate Language
  • English
Home / Symptoms / FND Symptoms / Functional Facial Symptoms

Functional Facial Symptoms

Functional Facial Spasm / Dystonia

People with functional neurological symptoms can have symptoms affecting the face. These are much more common than was thought even 10 or 15 years ago although in fact they have been recognised for over a century.

The commonest type of functional facial symptom is spasm of the muscles around one eye or in the lower half of the face.

Typically functional facial spasm occurs in episodes and affects one half of the face. Muscles around the eye (called orbicularis oculis) go in to spasm which leads to narrowing of the eye opening with the eyebrow lower on the affected side (see picture below)

When functional facial spasm affects the lower half of the face then the corner of the mouth may be pulled down and sometimes the jaw is pulled over (See pictures of Lucy). The mouth is pulled down because of spasm of a muscle called platysma – this is the muscle we all have under the skin at the front of our neck

Less commonmly the corner of the mouth may be pulled up. The photo on the right above is from 1918 and is of a world war one soldier with ‘shell shock’ who has functional facial spasm.

Doctors who do not know about functional facial spasm may interpret the symptoms as those of a stroke…..

Im grateful to Lucy for consenting to her photos appearing on You can hear Lucy describing her symptoms on this BBC Radio 4 programme, Inside Health, broadcast in October.

These pictures show Lucy’s jaw tending to be pulled over to the right side of her mouth. In addition she has spasm of the platysma muscle on the right which is pulling her lip down on that side.

Click on the video below to see Lucy talking about her facial spasm. She also had some right arm and leg weakness. You can see that on the functional weakness page.

When the mouth is pulled down this can give the person with this problem an asymmetrical appearance that is often mistakenly interpreted as facial weakness. Doctors who do not know about functional facial spasm may interpret the symptoms as those of a stroke, even though this is a problem with muscle overactivity not muscle under activity as is typically seen in a stroke.

Functional facial spasm can happen on its own but it’s also quite common to have some of the other symptoms on this website, especially functional limb weakness. If functional limb weakness is present it is nearly always on the same side as the facial spasm, a fact which interests scientists trying to understand the basis of functional neurological symptoms in the brain

Although most episodes of functional facial spasm last minutes, it can last hours or in rare cases be there most of the time

Sometimes the tongue can be involved in the spasm too. Usually if this happens then the when the tongue is stuck out it points towards the same side as the facial spasm

The videos below are posted with the generous permission of Maria who has unusually persistent functional facial spasm on the right side of her face. She also has episodes of intermittent spasm on the left side which can be induced by contracting her facial muscles.

Maria describing persisting facial spasm on the right side
An attack of left sided facial spasm

How is the diagnosis made?

It’s important that the doctor making the diagnosis is familiar with other causes of facial spasm. One of the main differences is that spasm from the conditions listed below is usually quite brief (ie lasting seconds) whereas in functional facial spasm the overactivity lasts minutes or longer. There are other differences that an experienced neurologist can look for such as the pattern of spasm, triggering factors and associated symptoms.

Other conditions causing spasm in the facial muscles which are NOT classified as functional disorders include

Functional Facial weakness

This is rare. One of the situations this might be seen in is when someone has a functional speech disorder. Some patients find that they can’t close their mouth properly when they speak and this may be interpreted as facial weakness.

Functional droopy or closed eyelids (ptosis)

In functional facial spasm although the muscle around the eye is overactive the eyelid itself is not usually affected. But sometimes a droopy eyelid, called ptosis (pronounced TOESIS) can be the result of a functional neurological disorder. Particular care is required in making this diagnosis as there are many causes of ptosis such as myasthenia gravis, lax skin in the eyelid and brain diseases.

Occasionally the eyelids, instead of being weak as they are in ptosis, may keep shutting and be hard for the patient to open. By far the commonest cause of this is a condition called Blepharospasm which is a movement disorder that does not relate to functional disorders. But rarely this symptom can occur as a functional disorder. It can be particularly disabling since obviously if both eyelids are closed the person experiencing this symptom cannot see properly

Again, expertise, preferably from a doctor familiar with the manifestations of blepharospasm is essential.

Treatment of Functional Facial Spasm

It can make a difference to some people to know that the problem is muscle overactivity not underactivity.

Recognising triggers like stretching the muscles in your face or in some people sensitivity to light can be helpful.

If the abnormal movements are triggered by ‘stretching’ your facial muscles then it can be tempting to avoid that activity. Instead it might be worth trying to induce the movement deliberately so that your brain can become ‘desensitised’ to it, in a way that you are controlling (rather than being at the mercy of random episodes)

Likewise if light sensitivity is the issue then gradually exposing the eye to more and more light can be helpful.

Unlike some forms of dystonia Botox injections dont seem to be helpful for functional facial spasm

Its quite common for patients with functional facial spasm to have other functional symptoms especially functional limb weakness.

In some patients understanding the diagnosis appears to help by ‘retraining the brain’ which has developed abnormal movement in relation to facial movements (see diagram below)

oakcreek manufactured home window repair replace a glass window pane is home window repair coverd in renters insurance vinyl clad wood replacement windows windshield replacement in las vegas window screen repair price list sell to replacements milgard window latch replacement how to replace a window in a door window screen repair diy replace window in door impact window installation crystal replacement windows window replacement santa rosa timber replacement windows andersen window replacement cost estimator replacement windows chicagoland kentucky replacement windows windows tulsa replacement window blind repair service replacement windows troy mi window installation rochester mn window replacement new braunfels condensation on new replacement windows window glass replacement indianapolis window screen repair fort worth replace a window pane windows replacement bangor springs window fashions blind installation window air installation st louis window repair window well replacement colorado springs how to repair casement window crank window screen replacement tulsa

juicing for weight loss ncis new orleans christopher lasalle weight loss hydr xycut weight loss weight loss dancers fruits that make you lose weight what can i do to lose weight fast weight loss hypnosis ma what are the best pills to take to lose weight emily deschanel weight loss weight loss pills for women at walmart lithium weight loss is keto the best diet where is the first place you lose weight weight loss contraceptive pill how to lose weight with diabetes type 1 af weight loss pill keto factor pills big hoss weight loss 2021 keto ultra diet shark tank vegan weight loss results tomato plant weight loss pills reviews keto diet fail weight loss pills lose 20 pounds over the counter diet pills at walmart obesitrol weight loss pills lose weight fasting best cleansing diet pills keto diet experience diet pills phen phen prescribed weight loss pills white lightning diet pills side effects what time of day to take keto pills foods to avoid for keto diet nv rapid weight loss pills

best way to take cbd oil for ibs cv sciences cbd oil dosage where to buy cbd oil indianapolis jackson courage cbd oil different ways to use cbd oil good lucl boadt cbd oil how much cbd oil for chronic pain make own cbd oil full spectrum in mct oil does cbd oil help with stress dosage of cbd oil with tramadol hemp seed oil vs rosehip oil hemp oil vs canabis oil does hemp oil have omega 3 cbd oil in multivitamin drug tests charlottes web cbd oil advanced cbd oil brand best cbd oil for cronic pain hemp oil for pain and inflammation where can we find cbd oil in raleigh north carolina will you buy cbd oil near wewahitchka florida where can you get cbd oil in ny dragon ball cannabis oil cbd oil stimming cbd oil airport security cbd oil percentages buy strong cbd oil thc ellis cbd oil where to buy cbd oil for people earthy brown cbd oil lab reviews where is cbd oil made best cbd oil gummies on amazon average price for cbd oil cbd oil with marked dropper test to use for type of cbd oil

how does viagra work hd 1000 male enhancement foods that increase testosterone increase testosterone levels in men viagra for men for sale best testosterone pills in the market vitamin to increase testosterone level are penis enlargement pills scams the beast testosterone booster testosterone booster supplement reviews does working out increase testosterone in males male enhancement pills in dominican republic improve male sexual stamina male enhancement pill death does marijuana increase sex drive male enhancement pills rxtra foods increase testosterone men get viagra how to take sex pills cialis stopped working sexual enhancement exercises where can i sell male enhancement pills blue and red male enhancement pills male supplement reviews male growth enhancement pills that actually work fx48 solutions male enhancement pill african superman male sexual enhancement pills safe penis enlargement pills have you used penis enlargement pills is ok to mix male enhancement pills penis pills for diabetics how to increase my testosterone pills to remove cysts on penis testosterone pills rite aid