Treatment of Facial Dyskinesias with Pharmacological Interventions

Introduction to Facial Dyskinesias

Facial dyskinesias can present as dystonia, chorea, ballism, or a combination, often manifesting as face twitching, rigidity of facial muscles, and dysarthria 2, 3
Paroxysmal kinesigenic dyskinesia (PKD) is a specific type affecting approximately 70% of patients with facial involvement 3

The American Academy of Neurology recommends sodium channel blockers, such as carbamazepine and oxcarbazepine, as first-line treatments for PKD, with over 85% of patients achieving complete remission at low doses 1
Low-dose carbamazepine (50-200 mg/day) or oxcarbazepine (75-300 mg/day) achieves complete remission in more than 85% of PKD patients 1
Initial dosage recommendations are to start carbamazepine at 50 mg or oxcarbazepine at 75 mg for adults, and 1 mg/kg for children, with gradual titration 1

HLA-B*15:02 screening should be implemented before initiating carbamazepine treatment to reduce the risk of adverse cutaneous reactions 1
Medication should be taken at bedtime to minimize adverse effects like dizziness 1
Treatment decisions for PKD should consider the patient's age, attack frequency and severity, psychological impact, and personal preference, given that PKD is generally a benign disease with natural remission 1