UNUSUAL SYNKINETIC MOVEMENTS BETWEEN FACIAL-MUSCLES AND RESPIRATION IN HEMIFACIAL SPASM

We describe two cases of hemifacial spasm (HFS) with unusual synkineti c movements between facial muscles and respiratory activity. Patient 1 developed an idiopathic HFS. She underwent microvascular decompressio n surgery, followed by transitory facial nerve palsy; she recovered bu t later developed a facial synkinesia characterized by involuntary and forced eyelid closure on spontaneous and deep breathing; the orbicula ris oculi muscle was active also when her mouth was open (the so-calle d Marin-Amat syndrome). Patient 2, 1 year after a peripheral facial ne rve palsy (Bell's palsy), developed an HFS together with synkinetic mo vements between the orbicularis oculi muscle and respiration. In both cases electrophysiological studies showed pathological synkinetic elec tromyographic activity. An enhanced hyperexcitability of brain stem in terneurons and facial motoneurons could be suggested to explain the ph enomenon.