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Abstract: The patient presented with episodes of eyelid twitching 5 days before admission due to anxiety, agitation, and poor sleep. Three days before admission, the patient presented with orofacial twitching spasms with vocal disturbance during seizures, and then came to our hospital for consultation. A head CT examination showed bilateral lacunar cerebral infarction, and other tests were later completed, and the patient was finally considered to have eyelid spasms and facial dystonia due to Meige syndrome. Drug therapy was given, and the symptoms were relieved after treatment, and the patient’s status improved with good results.
Basic information】Female, 72 years old
Type of disease】Spasticity, Meige syndrome (idiopathic blepharospasm-oral mandibular dystonia syndrome)
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
【Treatment plan】Medication (Awakening Brain Injection, Blood Seton Injection, Vitamin B1 Tablets, Vitamin B12 Tablets, Thiopride Hydrochloride Tablets, Clonazepam Tablets, Metformin Hydrochloride Tablets)
[Treatment period] 7 days of hospitalization
Treatment effect】Symptom relief, patient status improvement, good treatment effect
I. Initial interview
At the time of admission, the family described: 5 days before admission, the patient had episodes of eyelid twitching due to anxiety, emotional excitement and poor sleep. The patient felt irritation in both eyes, fear of light, increased blinking, and reduced when yawning or eating. Three days before admission, the patient had another orofacial twitching spasm with vocal disturbance, no limb numbness, no slurred speech, no blurred vision, double vision, etc. He came to our outpatient clinic for definite diagnosis and treatment. The patient was told that he needed to continue to improve the examination after admission, and that he had previous diabetes mellitus with fair glycemic control.
II. Treatment history
Examination: general condition is good, speech is fine, body temperature: 36.5℃, blood pressure: 150/90mmHg, heart rate: 75 beats/min, respiration: 16 breaths/min, normal limb movement, no drooping of both eyelids. He was given a complete head magnetic resonance examination showing bilateral multiple lacunar cerebral infarcts, DWI without acute phase lesions, cerebral arteriosclerosis, and then given a complete laboratory test of glycosylated hemoglobin, blood and urine routine, liver and kidney function, etc. Combining these tests and symptoms, Meige syndrome (idiopathic blepharospasm-oral mandibular dystonia syndrome) was considered to cause blepharospasm and facial dystonia. The family was informed and agreed to the treatment plan. The family informed and agreed to the treatment plan. Cerebral protection was given with Awake Brain Jing injection, microcirculation was improved with Hemiceton injection, nerve nutrition with vitamin B1 and vitamin B12 tablets, spasticity was controlled with thiopride hydrochloride tablets, spasticity was improved with clonazepam tablets, and blood glucose was controlled with metformin hydrochloride tablets.
The above are the results of head MRI
III. Treatment effect
After medication, the frequency of eyelid spasms and orofacial convulsions decreased, but the seizures were still daily, but the duration of seizures was shorter and less severe. During the patient’s hospitalization, the endocrinology department was consulted to regulate blood glucose, which was well controlled. As the attending physician, he patiently explained the patient’s condition, and the patient’s anxiety and sleep quality improved.
IV. Notes
We are glad that after treatment the patient’s eyelid spasms and orofacial twitching symptoms have been relieved, and after discharge the patient was instructed to continue oral thiopride hydrochloride treatment. If there is a sleep disorder can be taken orally eszopiclone tablets, but it is not recommended to overdose, easy to produce dependence as well as side effects are large. Keep optimistic mood, communicate with friends and participate in more outdoor activities. As the patient himself has combined diabetes, it is recommended to exercise properly, keep your mouth shut, and open your legs. Diet is recommended to be low salt, low fat, low sugar diet and high quality protein diet. If the blepharospasm worsens again or even if the limbs shake and twitch, you need to seek medical attention promptly and improve the video EEG examination to clarify the presence of seizures if necessary.
V. Personal insight
The patient in this case presented with episodic bilateral eyelid spasms and facial dystonia-like involuntary movements, and Meige syndrome (idiopathic eyelid spasm-oral mandibular dystonia syndrome) was considered. This disease is a dystonia with paroxysmal tonic contraction of the affected muscle groups in seconds to minutes, and the presence of limb tremors, tongue bite, and urinary incontinence need to be noted, and needs to be differentiated from epileptic seizures. The clinical treatment is mainly pharmacological. If pharmacological treatment is not effective, local injection of botulinum toxin type A can be used, which is effective in about 80% of patients.