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Botulinum toxin A and trihexyphenidyl in treatment of meige syndrome: two case reports

Bekir Enes Demiryurek, Esra Demiryurek, Bilgehan Atilgan Acar, Aybala Neslihan Alag

Meige Syndrome or Segmental Craniocervical Dystonia Syndrome is a rare variant of dystonia. It is clinically accompanied by dystonia in facial, masseter, and trapezius muscles together with symmetrical blepharospasm. Even though drugs such as anticholinergic, antidopaminergic, benzodiazepines, and tetrabenazine are used with botulinum toxin in its therapy, success of therapy is low and side effects are a lot when they are used alone. In this study, we reported two cases with Meige syndrome, that were a 60-year-old male patient and a 50-year-old female patient who had ongoing dystonia complaints even though they had previously received other therapies and then were successfully treated with a combined therapy of trihexyphenidyl, which is an anticholinergic, and Btx without any side effect. This rare clinical picture is mostly supposed to have a psychogenic origin. Also, it is mainly confused with entity tardive dystonia in differential diagnosis. Clinicians should be careful in order not to miss out diagnosis of Meige Syndrome or establish misdiagnosis like psychogenic movement disorders in differential diagnosis. It also should be kept in mind that chance of success for treatment of Meige Syndrome increases with combined medical therapies such as Trihexyphenidyl and Btx.