The most common phenotype, isolated lower lip dystonia (A, B), in a patient with spontaneous remissions and intermittent ipsilateral jaw deviation; eyelid spasm may be ipsilateral (C) or contralateral to the lip pulling (D). Note that the contraction of frontalis muscle involves the eyebrow contralateral to the spasm of the orbicularis oculi (arrows indicate a false "other Babinski sign"); platysma involvement is always associated with ipsilateral lip involvement (E), which can rapidly fluctuate in severity and appearance (F, G, same case). Some patients demonstrate severe bilateral spasms of most facial musculature (H), which may remit after placebo (vibrating tuning fork application, I) and relapse with different phenomenology shortly thereafter (J).
From: Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial movement disorders: Clinical features and associated conditions. Mov Disord 2012; 27:1544.
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