Hemifacial Myokymia as the Presenting Feature of Multiple Sclerosis

Abstract

The clinical presentation of multiple sclerosis (MS) is variable and can pose a diagnostic challenge. A case of unilateral perioral myokymia as the revealing feature of MS is reported. We present the case of a 43-year-old male, observed in our outpatient clinic with a two-week history of continuous involuntary wavelike movement across the left side of his face. Neurological examination revealed left-sided facial myokymia with perioral involvement and hemifacial spasm. Brain magnetic resonance imaging (MRI) showed multiple white matter hyperintensities on T2/FLAIR, suggestive of demyelination, involving periventricular, juxta-cortical regions, and the corpus callosum. Cerebrospinal fluid (CSF) analysis showed CSF-specific oligoclonal bands. The diagnosis of relapsing-remitting multiple sclerosis was made according to the McDonald Criteria from 2017. This case illustrates an unusual presentation of MS and highlights the importance of awareness of possible MS in young adults with facial myokymia, more so when continuous and with perioral involvement.