Objective: To describe the prevalence of facial asymmetry due to hemihypomimia in a non fluctuating Parkinson disease (PD) cohort and compare it to age-matched controls. To describe correlations between hemihypomima and other clinical signs.

Background: The only reported data on hemihypomimia in PD suggests a prevalence of 6.4% (1). Hemihypomimia is defined as decreased mimicry on one half of the face compared to the other side (decreased nasolabial fold, drooping of the mouth angle; and/or decreased forehead wrinkles).

Method: Transversal and descriptive pilot study including consecutive, non-fluctuating and Hoehn and Yahr stage I and II PD patients seen between 2-4/2017 in 8 Spanish movement disorders centers. Age matched controls were recruited among unrelated care-givers. The study was approved by the local ethics committee and all participants signed informed consent. Demographic data was collected and facial expression was filmed (at rest, showing teeth and raising eye brows). Patients underwent MDS UPDRS exam. Consecutive photograms of video recordings at rest and during actions were reviewed blindly by 3 neurologists to determine the presence of asymmetry/hemihypomimia (if discrepancy, final decision was based on majority). Each subject received three evaluations (symmetric/left hypomimia/right hypomimia at rest, showing teeth and raising eye brows) and a global score. Fisher’s exact tests were done with R (3.1.2) to explore differences between groups and associations between categorical variables.

Results: 46 patients (mean age 67.4±8.5, age at PD onset 62.5±8.4, MDS UPDRS 25± 10) and 35 controls (mean age 65.3±12.4) participated. Global facial asymmetry was more prevalent in PD patients (46.6%) than controls (20.6%) (p<0.019). In the control group, facial asymmetry was equally present in the lower and upper face. In the patient group, asymmetric facial bradykinesia was more salient in the lower half of the face than the upper face. Right and left sided hemihypomimia were similarly prevalent. Among patients with hemihypomimia, 62% had upper limb involvement as the first symptom at disease onset.

Conclusion: In this cohort 1) facial asymmetry was significantly more prevalent in the PD group than in the control group, 2) hemihypomimia affected 46.6% of the patients, and 3) was more frequent among PD patients with upper limb involvement as the initial symptom.

References: Ozekmekçi S, Benbir G, Ozdogan FY, Ertan S, Kiziltan ME. Hemihypomimia, a rare persistent sign in Parkinson’s disease: follow up of 11 patients. J Neurol 2007;254:347-50.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkmim-a-transversal-pilot-study-on-hemihypomimia-in-parkinson-disease/