Brief Answer:
Benign problem--- happens to me on occasion as well

Detailed Answer:
Good evening. I am a neurologist from XXXXXXX Ohio, USA and I'd like to give you a couple of thoughts that should help you feel a little confident that this is very likely a benign problem which will resolve itself in time.

Involuntary muscle contractions in a person your age with no prior history of problems or health problems (and especially in the face) mostly are of an unknown, temporary, and benign origin. Such contractions can occur as a result of several phenomenon such as electrolyte disturbances in the body, irritation of muscle fibers from mild or minor toxic substances of a either a chemical or traumatic nature (i.e. minor injury sustained to the left face).

Of course, there are other potential causes of this type of activity which can be tumorous lesions in the brain or SIDE EFFECTS of medications. The easiest way to look at these diagnostic possibilities is to obtain imaging studies of the brain with contrast as well as looking up side effects of any medication you're taking which could be fairly recently or otherwise, not frequently taken by you....you mention that you are on pain killers. Semi-synthetic narcotics such as tramadol have been known to cause muscle twitching in some patients which go away after the medication is stopped..

Demyelinating lesions (nerves with stripped axons of their insulating material) could also create this type of twitching. But again, according to the statistics and probabilities of this type of situation without more information is that the muscles involved are being directly irritated by something which often times is not identifiable.

Perhaps, it would help if I told you that my concern for an entity such as either ALS, Parkinson's Disease, or Epilepsy are all between the probabilities of "Darn Near Impossible" on the high end of the % scale to "I know an INTELLIGENT POLITICIAN who cares about the world!" which is the equivalent of ABSOLUTELY IMPOSSIBLE.

The truth of the matter though is this...ultimately, you will have to let this play out for a bit to see in which direction it goes before being able to absolutely and intelligently classify as well as name exactly what's going on and what the operative diagnosis should be.....If it calms down and then, starts back up in 1, 2, 3 months again then, you will CLEARLY need an imaging study of the cervical spine and the brain and you may also benefit from an ELECTROENCEPHALOGRAM of the brain though this test is likely to come out negative for seizures from everything you're describing.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 27 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
Need neurological consultation and workup

Detailed Answer:
Well, with that bit of information I would recommend the following if not already accomplished:

1. First and foremost- Neurology referral. Not sure what an ENT specialist would be able to offer in this type of situation. These are muscle twitches (by your description) which are in territories of cranial nerves and that's a central nervous system or possibly peripheral nervous system type of issue.

2. If this abnormal contractile activity has been stable for the past 12 months then, it very well may be a benign process. If it's been getting worse then, I think it deserves an imaging study of the brain and preferably an MRI with Gadolinium contrast. A CT scan (even if contrasted) is not terribly sensitive to the BRAINSTEM region which is where the cranial nerves controlling this part of the facial anatomy are located. An MRI is the most sensitive and I would also ask for FINE CUTS through the brainstem.

3. Consider performance of an EMG/NCV test is an electrical test which will measure the activity in the facial muscles being innervated and this can be helpful in determining certain disorders based upon waveforms and electrical signal characteristics of both sound and frequency as to what types of disease processes may be causing the problem.

4. A neurological examination will be able to allow the clinician to determine by visual assessment whether or not you may be suffering from an entity such as BENIGN FASCICULATION SYNDROME vs. FACIAL DYSKINESIAS or SEGMENTAL DYSTONIA.

5. If you have not had a full and complete battery of bloodwork then, I would definitely order things such as standard electrolytes, hepatic and renal function tests, Magnesium, Total Calcium, and Ionized Calcium levels. I would then, consider ordering (based upon the previous numbers) parathormone levels (PTH), Thyroid function tests (Total T4, Free T4, Total T3, Free T3), and I would also get the following: CPK, ESR, C-reactive Protein

6. As much as I would love to agree to smoking cigarettes would have something directly to do with your problem....just to SCARE YOU into quitting....that wouldn't be very professional on my part since in my heart of hearts I know that smoking has never been identified as either a risk factor or contributing/exacerbating/precipitating agent to this type of problem.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 45 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---