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What Causes Nerve Twitches On Left Side Of Brain And Face?
Question: I have been having this nerve twitches on the left side of my face and brain. There is this pain too when I touch the ear bone. I have also had cramps below my ear and jaw when I open my mout wide. What can it be? I also had facial paralysis on that side of my face.
Brief Answer:
Neuropathy of the facial nerve
Detailed Answer:
Hi. Thank you for writing to HCM.
What you are describing sounds like inflammation or irritation of the facial nerve. The facial nerve supplies the muscles of the face (used for chewing and facial expressions). It may be due to a viral infection or local irritation around the styoid process ( a bony prominence near the ear bone or mastoid bone), mastoid bone or parotid gland. This can explain why your pain worsens when you touch the ear bone. Facial nerve irritation or neuropathy may also be due to compression of the nerve due to surrounding swelling or mass. The twitching is due to local irritation of the nerve as it is firing electrical signals intermittently.
It is therefore my opinion that you visit your ENT specialist to evaluate the facial nerve on the effected side through out its course from the middle ear to its terminal branches within the parotid gland.
This includes
1. Ultrasound of the parotid region on the effected side
2. Contrast enhanced high resolution CT scan of the temporal bone on the effected side
3. A blood workup - complete blood count (wbc and differential counts to see if there is a viral pathology or immune deficiency), serum vitamin B12 and folic acid levels (vitamin deficiency can lead to neuropathy), blood sugars ( diabetes effects nerves) and ESR to see if there is any chronic disease.
4. Nerve conduction studies may also be indicated
Hope this information helps. For the time being you may start yourself on multivitamin supplements once daily and good anti-inflammatory medications. Oral steroids and medicines for neuropathic pain such as amytryptalline (which you have tried before) will help relieve your symptoms. Discuss my recommendations with your ENT specialist and take a prescription for these medications. Also have another similar condition called as trigeminal neuralgia ruled out. It may coexist in such circumstances.
Do write to me for any further questions.
Neuropathy of the facial nerve
Detailed Answer:
Hi. Thank you for writing to HCM.
What you are describing sounds like inflammation or irritation of the facial nerve. The facial nerve supplies the muscles of the face (used for chewing and facial expressions). It may be due to a viral infection or local irritation around the styoid process ( a bony prominence near the ear bone or mastoid bone), mastoid bone or parotid gland. This can explain why your pain worsens when you touch the ear bone. Facial nerve irritation or neuropathy may also be due to compression of the nerve due to surrounding swelling or mass. The twitching is due to local irritation of the nerve as it is firing electrical signals intermittently.
It is therefore my opinion that you visit your ENT specialist to evaluate the facial nerve on the effected side through out its course from the middle ear to its terminal branches within the parotid gland.
This includes
1. Ultrasound of the parotid region on the effected side
2. Contrast enhanced high resolution CT scan of the temporal bone on the effected side
3. A blood workup - complete blood count (wbc and differential counts to see if there is a viral pathology or immune deficiency), serum vitamin B12 and folic acid levels (vitamin deficiency can lead to neuropathy), blood sugars ( diabetes effects nerves) and ESR to see if there is any chronic disease.
4. Nerve conduction studies may also be indicated
Hope this information helps. For the time being you may start yourself on multivitamin supplements once daily and good anti-inflammatory medications. Oral steroids and medicines for neuropathic pain such as amytryptalline (which you have tried before) will help relieve your symptoms. Discuss my recommendations with your ENT specialist and take a prescription for these medications. Also have another similar condition called as trigeminal neuralgia ruled out. It may coexist in such circumstances.
Do write to me for any further questions.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I have done a complete WBC count and differentials.
Haematocrit, Pvc - 40%
WBC COUNT - 4,500
Neutrophil - 54%
Lymphocyte - 38%
Eosinophil - 5%
Monocyte - 1%
Haematocrit, Pvc - 40%
WBC COUNT - 4,500
Neutrophil - 54%
Lymphocyte - 38%
Eosinophil - 5%
Monocyte - 1%
Brief Answer:
WBC Count on the lower side
Detailed Answer:
Hi. Thanks for writing back.
A normal WBC count ranges from 4000 to 11000 cells per microlitre. Your WBC counts are closer to the lower limit and this could be because of medications or decreased immunity. This may need to be repeated in a month to see if it falls further or rises to a more acceptable level (7000-9000). The rest of your differentials fall within the normal limits.
Please do proceed with other investigations as recommended and have your ENT start you on medications for facial nerve neuropathy or if something else is identified during your investigations.
Do keep me posted. Would be happy to help with any other questions that you may have.
WBC Count on the lower side
Detailed Answer:
Hi. Thanks for writing back.
A normal WBC count ranges from 4000 to 11000 cells per microlitre. Your WBC counts are closer to the lower limit and this could be because of medications or decreased immunity. This may need to be repeated in a month to see if it falls further or rises to a more acceptable level (7000-9000). The rest of your differentials fall within the normal limits.
Please do proceed with other investigations as recommended and have your ENT start you on medications for facial nerve neuropathy or if something else is identified during your investigations.
Do keep me posted. Would be happy to help with any other questions that you may have.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks doc. Just don't like all this health stuff and tests.
I also realised there are days this twitching doesn't occur and it's been off and on since 2002.
And it's worst when am stressed or when am afraid of something like flying. The twitching becomes worst. Sometimes I don't feel it for days. Sometimes the cramp around the area behind the ear bone is always very painful and that cramp can occur when I yawn or try to open my mouth wide.
There is actually no pain unless I touch that ear bone.
Its just the twitching that drives me nuts.
I feel more comfortable discussing with you here as we don't have so many experts here.
Are you also sure the facial palsy I had on the same side of the face in 1991 is not playing a part?
Thanks
I also realised there are days this twitching doesn't occur and it's been off and on since 2002.
And it's worst when am stressed or when am afraid of something like flying. The twitching becomes worst. Sometimes I don't feel it for days. Sometimes the cramp around the area behind the ear bone is always very painful and that cramp can occur when I yawn or try to open my mouth wide.
There is actually no pain unless I touch that ear bone.
Its just the twitching that drives me nuts.
I feel more comfortable discussing with you here as we don't have so many experts here.
Are you also sure the facial palsy I had on the same side of the face in 1991 is not playing a part?
Thanks
Brief Answer:
It is a chronic nerve irritation
Detailed Answer:
Hi. I understand your concerns related to health tests.
It is possible or rather very likely that this may be related to your facial palsy in 1991. As the nerve heals it often heals incompletely or takes fibres from neighbouring nerves and can create many of the symptoms that you have.
It is also common to note that neuropathic conditions worsen under emotional stress especially when the muscles of the face play an important role in emotions and these fibres work in synchrony with emotional responses. It is also common that on touching over the irritated nerve it can generate pain and the area behind the ear is the closest one can get to pressing over the facial nerve.
So it is probably alright to not undergo these tests but it is recommended if you are expecting a complete or better recovery. There is a possibility that something completely treatable may surface from these investigations and may cure you from the disease. This is a small chance though but still a chance. However, looking at your long standing history these tests may also be inconclusive in which case we are left with medications for neuropathy that may need to be continued for years together. They may need to be titrated in a way that your symptoms can be managed during expected exacerbations.
Prescriptions for such medications can not be given ethically on online forums such as these and a Clinician needs to concur with the diagnosis, determine dosage and combinations only after a clinical examination. It is therefore imperative that you seek opinion from your physician or ENT specialist for these medications.
Hope this helps.
It is a chronic nerve irritation
Detailed Answer:
Hi. I understand your concerns related to health tests.
It is possible or rather very likely that this may be related to your facial palsy in 1991. As the nerve heals it often heals incompletely or takes fibres from neighbouring nerves and can create many of the symptoms that you have.
It is also common to note that neuropathic conditions worsen under emotional stress especially when the muscles of the face play an important role in emotions and these fibres work in synchrony with emotional responses. It is also common that on touching over the irritated nerve it can generate pain and the area behind the ear is the closest one can get to pressing over the facial nerve.
So it is probably alright to not undergo these tests but it is recommended if you are expecting a complete or better recovery. There is a possibility that something completely treatable may surface from these investigations and may cure you from the disease. This is a small chance though but still a chance. However, looking at your long standing history these tests may also be inconclusive in which case we are left with medications for neuropathy that may need to be continued for years together. They may need to be titrated in a way that your symptoms can be managed during expected exacerbations.
Prescriptions for such medications can not be given ethically on online forums such as these and a Clinician needs to concur with the diagnosis, determine dosage and combinations only after a clinical examination. It is therefore imperative that you seek opinion from your physician or ENT specialist for these medications.
Hope this helps.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Doc!
I have repeated the wbc and differential count like you suggested. Below is the new result:
OLD RESULT
Haematocrit, Pvc - 40%
WBC COUNT - 4,500
Neutrophil - 54%
Lymphocyte - 38%
Eosinophil - 5%
Monocyte - 1%
NEW RESULT
Haematocrit, Pvc - 43%
WBC COUNT - 5,500
Neutrophil - 50%
Lymphocyte - 30%
Eosinophil - 5%
Monocyte - 4%
I have repeated the wbc and differential count like you suggested. Below is the new result:
OLD RESULT
Haematocrit, Pvc - 40%
WBC COUNT - 4,500
Neutrophil - 54%
Lymphocyte - 38%
Eosinophil - 5%
Monocyte - 1%
NEW RESULT
Haematocrit, Pvc - 43%
WBC COUNT - 5,500
Neutrophil - 50%
Lymphocyte - 30%
Eosinophil - 5%
Monocyte - 4%
Brief Answer:
Improvement in immune system noted
Detailed Answer:
Hi. Thanks for writing back and repeating the blood tests.
From this new result it is clear that your WBC's have improved and your immune system is recovering. Also it appears as though there is no bacterial or viral infection.
It therefore appears that the nerve irritation is due to some other factor which may be something local around the exit of the facial nerve from the bone behind the ear. Or it may be that since the nerve is slowly recovering it is causing your symptoms in the process.
I understand your apprehensions towards an ENT consult and carrying out other tests, however it is my recommendation to have them done if you are particular to find out if there is some easily treatable cause for the nerve irritation.
It is also a very likely possibility that after the other investigations and ENT examination the results may still be inconclusive. In which case it may be assumed that the nerve irritation is a part of the healing process or due to vitamin B12 deficiency.
If your symptoms are not too bothersome, it is a reasonable approach to wait and watch as well.
In my opinion, in whichever approach that you may choose to take, I would recommend that you start yourself on some multivitamin supplements once daily for a few months. If that brings improvement than you may continue it for upto an year till maximum recovery is achieved.
Hope this helps. Do let me know if you have any further questions.
Improvement in immune system noted
Detailed Answer:
Hi. Thanks for writing back and repeating the blood tests.
From this new result it is clear that your WBC's have improved and your immune system is recovering. Also it appears as though there is no bacterial or viral infection.
It therefore appears that the nerve irritation is due to some other factor which may be something local around the exit of the facial nerve from the bone behind the ear. Or it may be that since the nerve is slowly recovering it is causing your symptoms in the process.
I understand your apprehensions towards an ENT consult and carrying out other tests, however it is my recommendation to have them done if you are particular to find out if there is some easily treatable cause for the nerve irritation.
It is also a very likely possibility that after the other investigations and ENT examination the results may still be inconclusive. In which case it may be assumed that the nerve irritation is a part of the healing process or due to vitamin B12 deficiency.
If your symptoms are not too bothersome, it is a reasonable approach to wait and watch as well.
In my opinion, in whichever approach that you may choose to take, I would recommend that you start yourself on some multivitamin supplements once daily for a few months. If that brings improvement than you may continue it for upto an year till maximum recovery is achieved.
Hope this helps. Do let me know if you have any further questions.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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