Meiges

Meiges, commonly referred to as Meige syndrome, is a focal dystonia of the cranial muscles that typically presents as a combination of blepharospasm (involuntary eye closure) and oromandibular dystonia (involuntary movements of the jaw, lips, and tongue). The condition is often described as a syndromic overlap rather than a single isolated symptom and may be labeled as Meige syndrome or Meige’s syndrome. In some older literature it has been associated with the term Brueghel syndrome.

Most cases begin in mid- to late adulthood and show fluctuating patterns of severity, with episodes of stronger spasms that can interfere with blinking, speaking, chewing, and facial expression. Patients may notice symptoms are worsened by stress or fatigue and may improve with relaxation or certain medications. Some individuals experience progression to involve additional facial or neck muscles, though the course is highly variable.

Etiology is usually idiopathic, but genetic susceptibility and environmental factors are suspected. Meiges is categorized within the spectrum of cranial dystonias and is thought to involve dysfunction in basal ganglia–thalamocortical circuits and sensorimotor processing. Secondary causes are uncommon but can include drug-induced or other neurological conditions; comprehensive evaluation helps exclude alternative diagnoses.

Diagnosis is clinical, based on characteristic patterns of blepharospasm and oromandibular dystonia, with consideration given to other eyelid or facial movement disorders. Imaging or electrophysiology is not routinely required but may be used to exclude other conditions.

Treatment is individualized and often multidisciplinary. Botulinum toxin injections into affected eyelid and facial muscles are the first-line therapy and can substantially reduce symptoms. Oral medications such as anticholinergics, benzodiazepines, or baclofen may provide additional relief for some patients. In refractory cases, surgical options like deep brain stimulation targeting the GPi may be considered. The condition is chronic and management focuses on symptom control and quality of life.

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