Role of the “other Babinski sign” in hyperkinetic facial disorders

Abstract

Background: The "other Babinski sign" consists in the co-contraction of the orbicularis and frontalis muscles, causing an eyebrow elevation during ipsilateral eye closure. It cannot be voluntarily reproduced. Aims of the study: To determine the utility of this sign in the differential diagnosis of hyperkinetic facial disorders. Methods: The presence of the sign was assessed in consecutive patients with blepharospasm, primary hemifacial spasm or post-paralytic facial syndrome treated in a botulinum toxin outpatient clinic. Results: Of the 99 patients identified, 86 were included, 41 with blepharospasm (32 female, mean age 71 ± 11 years), 28 with hemifacial spasm (16 female, mean age 65 ± 12 years) and 17 with post-paralytic facial syndrome (14 female, mean age 50 ± 17 years). The sign was detected in 67.9% of the patients with hemifacial spasm, in 23.5% of the post-paralytic facial syndrome group and in none of the patients with blepharospasm, exhibiting a sensitivity of 51% and a specificity of 100% for the diagnosis of hemifacial spasm/post-paralytic facial syndrome and a specificity of 76% for hemifacial spasm, compared to post-paralytic facial syndrome. Conclusions: This sign is highly specific for the diagnosis of peripherally induced hyperkinetic facial disorders. Its assessment should integrate the routine examination of patients with abnormal facial movements.

They Look but Do Not See—Gaze‐Evoked Eyelid Spasm

“…The Babinski sign is thought to be more specific to hemifacial spasm (seen in no cases of blepharospasm in one series). 5 The clinical features in our patient might superficially mimic Duane syndrome, in which aberrant innervation of the 6th and 3rd nerves causes globe retraction on attempted horizontal gaze that produces ptosis. However, unlike Duane syndrome, our patient had normal eye movements, no globe retraction, the presence of sensory tricks and pain.…”

“…Pain is exceedingly uncommon in blepharospasm (0.8–5.3%), 4 but possibly more common in hemifacial spasm. The Babinski sign is thought to be more specific to hemifacial spasm (seen in no cases of blepharospasm in one series) 5 …”

Symptom of Hemifacial Spasm Is Not Affected By State of Consciousness: A Case Report

“…There was one signi cant diagnostic clue as orbicularis oculi and eyelids contracting, internal part of the frontalis contracted and ipsilateral eyebrow rising. So called the 'Babinski-2' sign, 'the other Babinski sign' or 'brow lift sign' and was rstly described by Babinski in 1905 [6][7][8][9]. It means the synchrony of the temporal and zygomatic branches of the facial nerve causing simultaneous contraction of the frontalis and orbicularis oculi muscles, which is missing from other facial spasm disorders, such as blepharospasm and hemifacial seizures.…”

Hemifacial spasm is not affected by state of consciousness: a case report

“…One important diagnostic clue of HFS is called the ‘Babinski-2 sign’, ‘the other Babinski sign’ or ‘brow lift sign’ and was firstly described by Babinski in 1905 [ 6 – 9 ]. It refers to the synchrony of the temporal and zygomatic branches of the facial nerve resulting in simultaneous contraction of the frontalis and orbicularis oculi muscles, which is not seen in other facial spasm disorders such as blepharospasm and hemifacial seizures.…”