Author Response: Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis

We appreciate the comments on our case.¹ Although we agree that a bilateral hemifacial spasm is typically characterized by asynchronous muscle contractions on the left and right sides, contractions are also often asymmetric in severity, as observed in our case. The cheek movements on the right side of the face were likely the consequence of a stronger contraction of the palpebral part of the orbicularis oculi muscle, rather than the result of cheek muscle contractions as the orbicularis oris did not move during spasms. While a central origin cannot entirely be ruled out, the exclusive involvement of the upper facial muscles in our patient seems more consistent with a peripheral irritation of the superior branch of the facial nerves.

Moreover, our patient did not receive antiepileptic drugs, and the facial spasms resolved promptly after administration of high-dose intravenous methylprednisolone. We obtained an EEG study 4 days after onset of the facial spasm (approximately 2 days after their resolution), which was normal. At last follow-up, nearly 4 years after disease presentation, no other recurring or unprovoked episodes of facial spasm were reported by the patient.