Objective: To give a brief picture about the challenge of diagnosing and treating patients with Meige syndrome and to report a case of Meige syndrome in Indonesia, which was successfully treated with haloperidol.

Background: Meige syndrome (MS) is a movement disorder involving blepharospasm and oromandibular dystonia. There is still no specific test to diagnose MS which makes the diagnosis quite challenging. Even though several oral medications have been used to treat MS, the response of the therapy for every patient is very individual.

Method: ​​​​ A 57-year old male presented to our neurology clinic with symptoms of blepharospasm and oromandibular dystonia which persisted for one year. He has histories of type II Diabetes Mellitus, coronary heart disease, congestive heart failure. He had never taken any neuroleptic drugs before. Brain MRI showed multiple lacunar infarcts of left basal ganglia, right corona radiata, left-right parietal subcortex, with mild brain atrophy. As soon as the diagnosis was established, the patient was first treated with clonazepam then changed to haloperidol.

Results: A thorough examination needed to be done considering this patient has several previous medical histories. It was important to eliminate any treatable etiologies related to this patient’s symptoms such as the possibility of hyperglycemia-induced involuntary movement. The MRI findings can not be surely proclaimed to be the cause of the patient’s symptoms. After diagnosis was established, another challenge was choosing the oral medication for the patient. Haloperidol which acts as a dopamine D2 receptor antagonist was given and the symptoms drastically improved.
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Conclusion:
Clinicians need to consider the possibility of an MS diagnosis in patients with suggestive blepharospasm and oromandibular dystonia. It is necessary to rule out the possibility of any treatable etiologies related to the patient’s symptoms. Haloperidol can be considered for the treatment of patients with MS even though the effectiveness still needs to be studied further.

References: 1. Jahngir MU, Ameer MA, Patel BC. Meige Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Feb 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513358/
2. Ma H, Qu J, Ye L, Shu Y, Qu Q. Blepharospasm, Oromandibular Dystonia, and Meige Syndrome: Clinical and Genetic Update. Frontiers in Neurology [Internet]. 2021 [cited 2022 Feb 15];12. Available from: https://www.frontiersin.org/article/10.3389/fneur.2021.630221
3. Meige Syndrome: What’s in a Name? [Internet]. [cited 2022 Feb 19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743078/
4. Pandey S, Sharma S. Meige’s syndrome: History, epidemiology, clinical features, pathogenesis and treatment. J Neurol Sci. 2017 Jan 15;372:162–70.
5. Kirton CA, Riopelle RJ. Meige syndrome secondary to basal ganglia injury: a potential cause of acute respiratory distress. Can J Neurol Sci. 2001 May;28(2):167–73.
6. Alkaissi HR, Al-Sibahee E. Diabetes Mellitus Manifests As Focal Dystonia. Cureus [Internet]. 2021 Nov 25 [cited 2022 Feb 16];13(11). Available from: https://www.cureus.com/articles/77874-diabetes-mellitus-manifests-as-focal-dystonia
7. Oromandibualr Dystonia Associated with Diabetic Hyperglycemia [Internet]. [cited 2022 Feb 16]. Available from: https://www.jkna.org/journal/view.php?number=6182

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