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Bilateral facial synkinesis in leprosy
Hardeep Singh Malhotra1, Ravindra Kumar Garg, Madhu Mati Goel
1Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. drhsmalhotra@gmail.com
BMJ Case Reports
|June 7, 2012
Summary
Leprosy can cause rare facial synkinesis, a condition where facial movements become involuntary and linked. This case highlights nerve damage and mis-reinnervation in a leprosy patient, even after treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Leprosy is a significant cause of cranial nerve palsy in endemic regions, affecting up to 17.6% of patients.
- Facial nerve involvement in leprosy can lead to various neurological complications, including synkinesis.
Observation:
- A 35-year-old male presented with right-sided facial numbness and abnormal nasal sensations.
- Clinical examination revealed trigeminal nerve involvement and rare bilaterally symmetrical facial synkinesis affecting the orbicularis oculi and nasalis muscles.
- Modified blink reflex studies showed responses consistent with mis-reinnervation in the affected facial muscles.
Findings:
- Skin and sural nerve biopsies confirmed leprosy with acid-fast bacilli and granulomas.
- Despite 3 months of WHO multi-drug therapy, facial sensations improved, but the synkinetic movements persisted.
- The findings suggest that while leprosy treatment can improve sensory deficits, motor nerve regeneration may lead to persistent synkinesis.
Implications:
- This case underscores the importance of recognizing facial synkinesis as a potential complication of leprosy.
- Understanding the mechanisms of mis-reinnervation is crucial for managing neurological sequelae of leprosy.
- Further research into targeted therapies may be needed to address persistent facial synkinesis in leprosy patients.
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