Dear Dr. Roach: For about the past year, I have had mouth movements that I do not intend to make. I can stop them if I concentrate on doing so, but as soon as I think of something else, they resume. I also have involuntary movements on the left side of my mouth when I am about to fall asleep, or maybe when I have already fallen asleep. I make a loud noise, which wakes me up. The left side of my face is twitching wildly. Sorry I don’t know how to better explain this, but I am partly asleep when it happens and don’t know anything else. Do you have any idea what could be going on? — L.S.
Answer: There are several movement disorders that affect the face, some of which can cause tics, which is what it sounds like you are describing. Tics can occur by themselves, or in the context of another condition. An example of this is Tourette’s syndrome, which has a range of clinical expressions and does not always look the way it is portrayed in movies.
Some movement disorders are related to medication use, so a neurologist evaluating you would do not only a careful exam, but a thorough review of past medication use.
Dear Dr. Roach: I’ve heard of a new treatment for enlarged prostate called PAE. I understand it is a procedure that restricts blood flow to the prostate, causing it to shrink. Have you heard of it and any downsides? — W.G.
Answer: Prostate artery embolization is a new procedure, and the benefits and risks are not as well understood as for more commonly used procedures. Complications can happen up to 26% of the time. Post-PAE syndrome has been described. It includes a burning sensation, nausea and vomiting. Given the lack of certainty about the relative effectiveness about this procedure compared with traditional options, the American Urological Association has recommended PAE be used only in the setting of a clinical trial.
