Seek neurologist for mouth, face twitch

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 really concentrate on doing so. Lately, I also have involuntary movements when I am about to fall asleep. I make a loud noise, which wakes me up. Do you have any idea what could be going on? — L.S.

There are several different 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 neurological condition. A good example of this is Tourette’s syndrome, which has a wide 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. It’s 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.

Prostate artery embolization uses plastic beads to block the arteries in the prostate, causing cell death and shrinkage of the prostate. In theory, that will improve symptoms of enlarged prostate.

It is a new procedure, and the benefits and risks are not as well understood. Complications, especially urinary retention, 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 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.