 Hemifacial myokimia is another disorder of the seventh nerve, but in this case probably due to brain stem involvement. This is a patient with multiple sclerosis and what you can see are continuous undulating fasciculation-like contractions in the distribution of the seventh nerve. Now, this disorder is different than the benign obicularis myokimia, which I think all of us have experienced during times of stress, that little twitching movement that you can feel under the eye. The difference in this disorder is that the movements spread to other areas of the seventh nerve, not just around the eye. Now, watch as we move downward. You can see these movements in other areas that are subserved by the seventh nerve. When you have a patient with this type of disorder, you need to think about intrinsic lesions of the brain stem, multiple sclerosis, tumor, for example. Look at these fasciculation-like movements. Continuous rippling undulations of the muscles subserved by the seventh nerve. Here we're shining light obliquely on the skin and it creates shadows. This is very similar to the technique that's very useful to bring out and show fasciculations in, for example, amyotrophic lateral sclerosis. Using room light that's from the sun, for example, bringing the patient up close to a room, is another way to bring out the shadows of these fasciculations.