Treatment of perioral dystonia with botulinum toxin in 4 cases of Meige's syndrome.
OBJECTIVE
We describe the treatment of 4 patients (median age, 53.5 years) with incapacitating perioral dystonia and insufficient response to peroral medication. Their general treatment with clonazepam and anticholinergics was supplemented by intramuscular injections with botulinum toxin A (20-40 U) in the orbicularis oris muscle, guided by electromyography (EMG).


METHODS
Perioral dystonia and treatment effect were assessed by using subjective global and visual analog scales, examiner-based video movement counts and rating scales, and quantitative EMG. t Tests were used for statistical analysis.


RESULTS
The result of the intramuscular botulinum toxin A injections was characterized by the patients as "much improved"; correspondingly, dystonia was significantly reduced in visual analog scale scores, on examiner-based assessments, and in recordings of EMG. The side effects were few and short-lasting.


CONCLUSIONS
Incapacitating perioral dystonia in Meige's syndrome may be safely controlled by recurrent EMG-guided botulinum toxin A injections in the orbicularis oris muscle, in combination with general medication.
Universtiy of Copenhagen, Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Eigild
E
Møller
Lene M
LM
Werdelin
Merete
M
Bakke
Torben
T
Dalager
Svend
S
Prytz
Lisbeth
L
Regeur
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D004421:Dystonia / Q000503:physiopathology / Q000628:therapy*; D004576:Electromyography; D005152:Facial Muscles / Q000503:physiopathology; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D008047:Lip Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008538:Meige Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome
D018680:Cholinergic Antagonists; D018757:GABA Modulators; D002998:Clonazepam; D019274:Botulinum Toxins, Type A