Recurrent facial twitches are most commonly due to hemifacial spasm, but this needs to be distinguished from other causes.
- Hemifacial spasm ( most common cause of recurrent facial twitches; peripherally induced, starts with eye then spreads, mild CN7 LMN weakness with slightly closed palpebral fissure)
- Essential blepharospasm (bilateral)
- Focal seizures (uncommonly localise to the face, e.g. epilepsia partialis continua)
- Facial myokymia (subtle, continuous, ripple-like quivering, usually over small areas of the face)
- Facial tics (usually not limited to one side)
- Bell palsy with aberrant regeneration and synkinesia (history CN7 LMN weakness preceding twitching)