Successful treatment of the Meige's syndrome with navigated repetitive transcranial magnetic stimulation: A case report

Abstract

1. IntroductionMeige's syndrome is a type of segmental cranial dystonia characterized by blepharospasm and oromandibular dystonia, often complicated with abnormal movement of maxillofacial and cervical muscles [[1]Pandey S. Sharma S. Meige's syndrome: history, epidemiology, clinical features, pathogenesis and treatment.J Neurol Sci. 2017; 372: 162-170https://doi.org/10.1016/j.jns.2016.11.053Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar]. Current treatments for Meige's syndrome include oral medications, botulinum toxin, and deep brain stimulation (DBS). However, these therapies were reported to either have unstable efficacy or cause unwanted side effects, or be invasive [[1]Pandey S. Sharma S. Meige's syndrome: history, epidemiology, clinical features, pathogenesis and treatment.J Neurol Sci. 2017; 372: 162-170https://doi.org/10.1016/j.jns.2016.11.053Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar]. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method which has been successfully used in movement disorders such as Parkinson's disease [[2]Latorre A. Rocchi L. Berardelli A. Bhatia K.P. Rothwell J.C. The use of transcranial magnetic stimulation as a treatment for movement disorders: a critical review.Mov Disord. 2019; 34: 769-782https://doi.org/10.1002/mds.27705Crossref PubMed Scopus (28) Google Scholar]. However, whether it can be used in Meige's syndrome remains unknown. Here, we report the successful treatment of Meige's syndrome with navigated rTMS in a patient with Meige's syndrome who is refractory to oral medication.2. Material and methods2.1 PatientThe patient is a 57-year-old woman who had three-years-history of blepharospasm and oromandibular dystonia complicated with abnormal maxillofacial movement before her first navigated rTMS treatment. During the first six months, she initially presented with right eyelid convulsion especially when she felt nervous, which gradually evolved bilaterally. In the following six months, the patient developed spontaneous mouth movements, inarticulacy, cervical stiffness, and resultant dysphagia. During the first year, the patient had been treated with botulinum toxin and haloperidol which was withdrawn because of side effects. In the next two years before her first rTMS treatment, she received anti-dystonia and supportive treatments, and she was prescribed medications including haloperidol, benzhexol hydrochloride and simvastatin. However, the dysphagia of the patient deteriorated, and she developed cough from water drinking. The patient refused the history of hypertension, diabetes, infectious diseases, smoking, alcohol addiction, and allergies. Written informed consent has been obtained from the patient. This study was approved by the ethics committee of Xijing Hospital and was conducted according to the Declaration of Helsinki.2.2 Navigated rTMS treatmentThe patient was enrolled and her first navigated rTMS treatment was carried out at the Department of Neurology, Xijing Hospital on July 27, 2020, with a CCY-1 stimulator (Yiruide Medical Equipment Company, China) using a figure 8 coil, following the safety guidelines and protocols for rTMS [[3]Rossi S. Hallett M. Rossini P.M. Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.Clin Neurophysiol. 2009; 120: 2008-2039https://doi.org/10.1016/j.clinph.2009.08.016Crossref PubMed Scopus (3508) Google Scholar]. Navigation was performed using a neuronavigational system (visor2, ANT Neuro, Enschede, Netherlands) to guide the magnetic stimulation as previously described [[4]Zhao C.G. Sun W. Ju F. Wang H. Sun X.L. Mou X. et al.Analgesic effects of directed repetitive transcranial magnetic stimulation in acute neuropathic pain after spinal cord injury.Pain Med. 2020; 21: 1216-1223https://doi.org/10.1093/pm/pnz290Crossref PubMed Scopus (19) Google Scholar]. Briefl