Meigs syndrome

Lopez de+, Clin Neuropharmacol 17(5), 481 Hypokinesia Insomnia Meige syndrome... 

Kebapci M, Aslan 0, Kaya T, Yalcin OT, Ozalp S (2002) Pedunculated uterine leiomyoma associated with pseudo-Meigs syndrome and elevated CA-125 level CT features. Eur Radiol 12[Suppl 3] S127-129... 

Fibromas are composed mostly of fibroblasts and spindle cells and abundant collagen contents. Fibromas are not hormonally active. Fifteen percent of fibromas are associated with ascites (Fig. 9.32), and in 1% pleural fluid is also found [83]. This triad of an ovarian fibroma, ascites and pleural effusion constitutes the benign Meigs syndrome, which can be associated with elevated Ca-125 levels [84]. In basal cell nevus syndrome, numerous basal cell carcinomas are associated with abnormalities of bones, eyes, brain, and tumors, including ovarian bilateral fibromas [85]. 

Timmerman D, Moerman P, Vergote I (1995) Meigs syndrome with elevated Ca-125 levels two case reports and review of the literature. Gynecol Oncol 59 405-408... 

A total of 182 patients (73 male, 109 female) with various facial region disorders were retrospectively studied using botulinum toxin injection for the treatment of facial region disorders [19 j. Improvement in symptoms was marked and good in subjects treated for blepharospasm, hemifacial spasm, facial s5mkinesis and Meige syndrome, and moderate for oromandibular dystonia and hypersalivation. Ptosis was the most common side effect. 

This chapter deals with botulinum toxin type A (BOTOX) in the treatment of strabismus, blepharospasm, and related disorders. Botulinum toxin type A (BOTOX) has been used to treat strabismus, blepharospasm, Meige s syndrome, and spasmodic torticollis. By preventing acetylcholine release at me neuromuscular junction, botulinum toxin A usually causes a temporary paralysis of the locally injected muscles. The variability in duration of paralysis may be related to me rate of developing antibodies to me toxin, upregulation of nicotinic cholinergic postsynaptic receptors, and aberrant regeneration of motor nerve fibers at me neuromuscular junction. Complications related to this toxin include double vision (diplopia) and lid droop (ptosis). 

The differential diagnosis includes idiopathic torsion dystonia, parkinsonism, idiopathic torticollis, Huntington s disease, Wilson s disease, and Meige s syndrome (blepharospasm, oromandibular dystonia). A retrospective evaluation of the records of patients with idiopathic cervical dystonias (n = 82) and tardive cervical dystonias (n = 20) has been performed, in a search for clinical features that could help separate these closely related disorders (332). Despite the overall similarity, the presence of a dystonic head tremor was strongly suggestive of the idiopathic form, which was present in 42% and did not occur at all in the tardive group. A family history of dystonia (10%) was also exclusive to the idiopathic group. 

Meige s syndrome is characterized by blepharospasm and spasm of the lower facial or oromandibular muscles (395). 

A 52-year-old woman developed Meige s syndrome 2 days after the appearance of akathisia. She had taken neuroleptic drugs for years, but her current medication had been changed to bromperidol 18 mg/day and trihexyphenidyl (benzhexol) 6 mg/day 2 days later she developed akathisia. Oral perphenazine 12 mg and trihexyphenidyl 6 mg dose-dependently reduced the frequency of blepharospasm the dosages of bromperidol and trihexyphenidyl were gradually reduced to 8 mg/ day and 3 mg/day respectively over 3 months, by which time her symptoms had completely disappeared. 

Hayashi T, Furutani M, Taniyama J, Kiyasu M, Hikasa S, Horiguchi J, Yamawaki S. Neuroleptic-induced Meige s syndrome following akathisia pharmacologic characteristics. Psychiatry Clin Neurosci 1998 52(4) 445-8. 

However, there was no evidence of a beneficial effect of clozapine in primary dystonia, the most common form of dystonia and a difficult disorder to treat, until the report of a 56-year-old woman with severe and persistent primary cranial dystonia (Meige s syndrome), who responded to clozapine (50-100 mg) (94). 

Sieche A, Giedke H. Treatment of primary cranial dystonia (Meige s syndrome) with clozapine. J Clin Psychiatry 115. 2000 61(12) 949. 

When blepharospasm is accompanied by periodic lower fecial movement, the disorder is referred to as Meige s syndrome or idiopathic orofacial dystonia. If the mandible also becomes involved, the disorder is referred to as Breughel s syndrome or oromandibular dystonia. When several cranial nerves are involved, the disorder is called segmental cranial dystonia. Although often discussed as separate entities, these dystonic syndromes may be the same disease process with variable clinical manifestations. 

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