Diagnosis face contractions and simultaneously abulia

[Dutch lady]

I am Dutch, discovered this forum and hope to receive help/ideas to find out what is happening to me since 2004 and how to deal with it.

My face has the following features (explained below); started since 2004 (age than: 33), and is not contineously present, however now seems to starts at the end of the menses (whereby my coginitive functions are best prior to the menses). These features are furthermore triggered upon streneous actions.

Features: the muscles on the right side of the face tend to contract; pulling my right eyebrow down and my right cheek upwards + to a lesser extent, the corner right mouth upwards (more or less squeezing my eye); simultaneously the left eye more open en the left eyebrow higher than the right eyebrow. Ptosis like.
When this happens,I am dizzy and cannot think straight, nor go into meetings, discuss things with people, etc. This tends to start at the end of the menses and is heavy for a day and lingers on afterwards for some days, going to the next menses, cognitive complaints diminish together with the face features.
I have tinnitus, but no other eyecomplaints, nor pains (luckely opposed to others here).


Despite the fact that this face is not appealing, I suffer more from the fact I am apatic at those moments, cannot think straight (abulia); work is problematic at those times.

Have been treated for lyme through antibiotics (AB) for 20 months (ended end 2007); no antigen lyme present any longer, only still P41 (both IGG and IGM); the neurologist (who btw did not treat my lyme, as a US LD did prior to my visit to the neurologist) says at first glance it is not related to Lyme; his arguments remain unknown to me. Despite the AB still have the face issue combined with the cognitive problems/apathy (absent feeling). This face is not diminishing since 2004, it is still there..(and the muscles are getting stronger and stronger on the right side).

Thank you for taking the time to read this


Look forward to any comments,

Thank you,

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the cause of your symptoms is but I will try to provide you with some useful information.

The contraction of your face may be due to hemifacial spasm, a type of muscle contraction referred to as segmental myoclonus. Hemifacial spasm can be due to an abnormality in the lower part of the brain called the brainstem or surrounding structures. However, in most patients, no MRI anormality is found, and the cause in most people is thought to be due to dysfunction of the 7th cranial nerve with no specific cause found. The treatment often is with botox injections to medically paralyze part of the muscle. Hemifacial spasm is a clinical diagnosis.

However your associated symptoms would not be consistent with hemifacial spasm, which is not usually associated with dizziness and thinking trouble and apathy.

Another possible cause of intermittent face contractions are seizures. An EEG during the episode of face contractions would be needed to exclude that these are seizures. Seizures can sometimes cause associated cognitive dysfunction. Sometimes, in some cases, seizure threshold is lowered during menses.

Your symptoms of cognitive dysfunction and apathy during mensis could be related to what is called menstrual dysphoric disorder, which is related to chemical changes resulting from hormonal changes. This is often treatable with medications such as prozac. Another possible cause of cognitive dysfunction and apathy are depression.
In general, other causes of cognitive dysfunction and lack of motivation include thyroid problems (which can be tested with a blood test called TSH), vitamin B12 deficiency, drug induced, excessive alcohol use, and some drugs such as marijuana.

Abulia is a specific term used to describe a syndrome of akinetic mutism, which often occurs following lesions to a specific part of the brain called the frontal lobes. Your symptoms are not really consistent with abulia.

While Lyme disease can cause neurologic problems like cognitive dysfunction and apathy, these would not be episodic. Lyme causes a chronic meningitis (inflammation in the fluid around the brain). Symptoms frequently include headache, altered sensorium) confusion and cognitive dysfunction. If you return to normal in between your episodes, then Lyme is unlikely. CNS infections with Lyme are diagnosed with testing of spinal fluid obtained after lumbar puncture.

I recommend continued follow up with your neurologist.

Thank you for using the forum I hope you find this information useful good luck.

[Dutch lady]

Thank you for taking the time and giving your comments.
All of the above started in 2004, and simultaneously received positive Elisa, WB IGG/IGM, which is now reduced to only P41 IGG/IGM. No HIV, CMV, EBV, etc. I had the headaches and other lymesymptoms, which dissapeared after AB. As part of his investigation, the Neurologist  did sent me to the pshychiater (who does not exactely know yet what to do with me, which will most likely be reported back to the Neurologist). EMG is negative. As indicated by you, I have MRI and EEG scheduled in coming days, which I can cancel when not suffering from the abovementioned complaints, which is the case). QEEG elsewhere was abnormal which doesnt seem to be of value as it was not done in the university hospital I am currently being treated. In case of any outcome, will get back to update.
I thank you.