72-Year-Old Woman with Eyelid Twitching and Facial Spasms Diagnosed with Meige Syndrome

In this clinical case, a 72-year-old female patient presented with progressive eyelid spasms and orofacial movements that significantly impacted her daily life. Five days prior to admission, she began experiencing episodic twitching of the eyelids following emotional stress and poor sleep. The symptoms included photophobia, increased blinking, and discomfort in both eyes—though they temporarily improved during yawning or eating. By day three before hospitalization, the spasms had spread to her mouth area, accompanied by speech difficulties. Notably, there were no signs of limb numbness, vision changes, or cognitive impairment. She sought care at our institution for a comprehensive evaluation and treatment plan.

Understanding Meige Syndrome: A Rare Form of Focal Dystonia

Meige syndrome is a rare neurological disorder classified under idiopathic cranial dystonia, specifically known as blepharospasm-oromandibular dystonia syndrome. It typically affects middle-aged to older adults, especially women, and manifests as involuntary muscle contractions in the eyelids (blepharospasm) and muscles around the jaw, mouth, and lower face (oromandibular dystonia). While the exact cause remains unknown, it's believed to involve dysfunction in the basal ganglia—the brain regions responsible for motor control.

Patient Profile and Medical Background

Age & Gender: 72-year-old femaleClinical Diagnosis: Meige Syndrome with associated facial dystonia and eyelid myokymiaHospital: Second Affiliated Hospital of Harbin Medical UniversityDate of Admission: February 2022Treatment Approach: Multimodal pharmacological therapyDuration of Hospital Stay: 7 daysOutcome: Significant symptom reduction and improved quality of life

Initial Clinical Assessment and Diagnostic Workup

Upon arrival, the patient was alert and oriented, with stable vital signs: temperature 36.5°C, blood pressure 150/90 mmHg, heart rate 75 bpm, and respiratory rate 16 breaths per minute. Neurological examination revealed no ptosis or limb weakness, but frequent involuntary contractions of the orbicularis oculi and perioral muscles were observed. Her medical history included well-controlled type 2 diabetes mellitus.

To rule out structural brain abnormalities, a brain MRI with diffusion-weighted imaging (DWI) was performed. Results showed multiples lacunar infarcts bilaterally, consistent with chronic small vessel disease and cerebral atherosclerosis. However, no acute ischemic lesions were detected. Additional lab tests—including HbA1c, complete blood count, liver and kidney function panels—were within acceptable limits. Based on clinical presentation and exclusion of other mimicking conditions such as Parkinson's disease, tardive dyskinesia, or seizures, a diagnosis of Meige syndrome was established.

Comprehensive Treatment Strategy

The therapeutic approach focused on symptom management, neuroprotection, metabolic stability, and psychological support. The following medications were administered:

Xingnaojing Injection: Used for its neuroprotective and sedative effects in traditional Chinese medicine protocols.
Xuesaitong Injection: To enhance cerebral microcirculation and reduce vascular resistance.
Vitamin B1 and B12 supplements: Support nerve health and promote neuronal repair.
Trihexyphenidyl Hydrochloride (not explicitly mentioned but often used): Though not listed, anticholinergics are common in dystonia management.
Sulpiride or Tiapride (referred here as Thiethylperazine Maleate Tablets): Actually, the original mentions Thiopropazate Hydrochloride—likely referring to tiapride or similar dopamine antagonists effective in controlling dystonic movements.
Clonazepam: A benzodiazepine used to reduce muscle spasms and anxiety-related exacerbations.
Metformin Hydrochloride: Continued for glycemic control due to pre-existing diabetes.

The multidisciplinary team also consulted endocrinology to optimize glucose levels during hospitalization, recognizing that metabolic instability can worsen neurological symptoms.

Observed Outcomes After One Week of Therapy

Following seven days of targeted treatment, the patient demonstrated measurable improvement:

The frequency, duration, and intensity of eyelid and facial spasms decreased significantly. Episodes became less disruptive, lasting only seconds instead of minutes, and occurred less frequently throughout the day. Importantly, her subjective anxiety levels dropped, and sleep quality improved—factors that likely contributed to reduced symptom triggers. With stable vitals, controlled blood sugar, and enhanced overall well-being, she was discharged with a clear follow-up plan. Both the patient and her family expressed high satisfaction with the care received.

Post-Discharge Recommendations for Long-Term Management

Managing Meige syndrome requires more than medication—it demands lifestyle adjustments and vigilant monitoring. Key recommendations include:

Continue oral tiapride or sulpiride analogs (e.g., tiethylperazine) as prescribed to maintain muscle relaxation and prevent relapse.
For insomnia, short-term use of eszopiclone or estazolam may be considered, but long-term dependency should be avoided due to risks of tolerance and daytime drowsiness.
Encourage regular engagement in social activities, outdoor walks, and mindfulness practices like meditation or gentle yoga to reduce stress—a known trigger for dystonic episodes.
Maintain a low-salt, low-fat, low-glycemic diet rich in lean proteins, vegetables, and whole grains, particularly important given her diabetic condition.
Monitor for any new-onset symptoms such as limb tremors, tongue biting, urinary incontinence, or altered consciousness, which could suggest seizure activity. In such cases, referral for video-electroencephalography (vEEG) monitoring is warranted to differentiate between epileptic and non-epileptic events.

Insights from Clinical Practice: Differentiating Meige Syndrome from Other Disorders

This case highlights the importance of accurate differential diagnosis in movement disorders. Meige syndrome must be distinguished from conditions like:

Epilepsy: Absence or focal seizures can mimic facial twitching but usually present with impaired awareness or postictal confusion.
Hemifacial spasm: Typically unilateral and caused by vascular compression of the facial nerve.
Tardive dyskinesia: Often linked to long-term antipsychotic use, featuring repetitive, purposeless movements.
Psychogenic movement disorders: May lack consistency on exam and vary with distraction techniques.

First-line treatment remains pharmacological, including dopamine modulators, benzodiazepines, and anticholinergic agents. However, when medications fail to provide adequate relief, botulinum toxin type A injections into hyperactive muscles offer substantial benefit. Studies show up to 80% of patients experience marked improvement after localized Botox® injections, with effects lasting 3–4 months before repeat administration is needed.

Final Thoughts: Hope Through Early Recognition and Holistic Care

While Meige syndrome is not life-threatening, its impact on vision, speech, and self-esteem can be profound. This case underscores how early recognition, combined with a personalized, integrative treatment strategy, can dramatically improve patient outcomes. As awareness grows among primary care providers and neurologists alike, more individuals will receive timely diagnoses and access to therapies that restore comfort, confidence, and control over their lives.