Dyskinesia — the involuntary and uncontrolled movement of any part of the body — can be as mild as a slight tremor of the fingers or toes, or as severe as uncontrolled movements of the entire hands or legs. These movements most often strike as a side-effect of long term medication. In some cases, dyskinesia may also be observed after an injury to the brain, or a stroke.
Repetitive or jerky movement of the face is called orofacial dyskinesia.
Why does orofacial dyskinesia occur?
Neurological conditions like schizophrenia, bipolar disorders, depression, and some other mental disorders, are usually treated with antipsychotic drugs, also known as neuroleptic drugs. Broadly, these drugs work by limiting the production of the hormone dopamine. This hormone is essential for smooth movements of the muscles of the body.
Who is most likely to suffer from orofacial dyskinesia?
Individuals who have been taking antipsychotic drugs for more than three months are most likely to be affected by orofacial dyskinesia. However, in certain rare cases, even a single dose can trigger this condition. Older-generation antipsychotic drugs like Haldol are more likely to cause orofacial dyskinesia, one reason for which they are now prescribed with caution.
As a demographic, females going through menopause, individuals over the age of 55, Asian Americans, African Americans, and those abusing alcohol and/or narcotics are more vulnerable to dyskinesia.
Persons suffering from HIV are also at a greater risk of developing orofacial dyskinesia.
Signs of orofacial dyskinesia
Patients suffering from orofacial dyskinesia show sudden, stiff, and jerky movements that are involuntary, random, and unpredictable. Most of these movements are of the face, including:
- Sticking out the tongue
- Rapid blinking of eyes
- Puffing up the cheeks
- Frowning and grunting
- Smacking lips
How do I know if I have orofacial dyskinesia?
Orofacial dyskinesia is most commonly seen in people who are on long term antipsychotics drugs. If you start to observe involuntary movements in two or more areas of the face or body, it is advisable to consult your physician to rule out any other conditions and to identify the dyskinesia at an early stage.
Early identification can help immensely in managing orofacial dyskinesia and preventing it from getting worse.
How to manage orofacial dyskinesia?
Drugs
While there are no known drugs to treat orofacial dyskinesia, certain drugs like clozapine, valbenazine, and deutetrabenazine have shown promising results during trials. Anti-anxiety drugs like clonazepam reduce the occurrence of involuntary movements. However, such drugs have a risk of nurturing dependence if used for a prolonged duration.
Vitamins and antioxidants
Vitamin B6, vitamin E, and antioxidants like Gingko Biloba have been used historically to manage orofacial dyskinesia, albeit, with limited success.
Botox
In some cases, botulinum toxin can be injected into the facial muscles, thereby freezing them and reducing the involuntary movements. This is perhaps, the most common treatment for moderate to severe cases right now.
Surgical intervention
In severe cases of orofacial dyskinesia, deep brain stimulation — in which electrodes are implanted in certain areas of the brain — can help. These electrodes regulate the abnormal impulses responsible for the sudden movements. Usually used for treating Parkinson’s disease, deep brain stimulation has been found to improve the condition of patients severely affected by orofacial dyskinesia as well.
Can you prevent orofacial dyskinesia from occurring at all?
Since there is no known treatment for orofacial dyskinesia, it is best to avoid the condition from developing in the first place. The dose of antipsychotic drugs should be kept at the lowest possible level. Newer drug compounds which are less likely to cause dyskinesia should ideally be prescribed.
Regular screening
Once a patient is started on antipsychotics, regular evaluation should be carried out, using a standardized test like the Abnormal Involuntary Movement Scale (AIMS), to detect the onset of orofacial dyskinesia at an early stage. If caught early, the medication can be switched to increase the chances of resolving the condition.
How to cope with orofacial dyskinesia?
It can be very difficult to live with orofacial dyskinesia due to the stigma associated with involuntary movements. The patient can feel frustrated and isolated, leading to immense amounts of stress. It is advisable to join a therapy group to share your frustrations and problems, among people who know how it feels to go through the condition.
Daily exercises like walking or swimming may be recommended. This can help in relieving stress. Stress management is important as stress is known to be a triggering factor for involuntary movements.
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