Case report on new injection method for treating female Meige syndrome patients

Abstract

Meige syndrome is an uncommon, long-lasting, and recurring form of craniofacial focal dystonia marked by bilateral blepharospasm and involuntary facial muscle contractions that greatly disrupt the daily activities and social interactions of those affected. The primary minimally invasive treatment for this condition is local botulinum toxin injection, recognized for its safety and ability to be repeated. According to established pharmacological principles, the blockade of the neuromusclar junction by botulinum toxin typically takes 3 to 7 days to show clinical effects, which is a result of the intracellular cleavage of SNARE proteins and the disruption of acetylcholine vesicle release. Nevertheless, traditionl periorbital injection have significant limitations, such as delayed onset, brief effectiveness, and a considerable risk of worsening eyelid weakness, ptosis, and incomplete eyelid closure. At present, there is no standardized individualized personalized approach for patients with Meige syndrome who also suffer from ongoing eyelid weakness. We report a case involving a middle-aged woman diagnosed with Meige syndrome, characterized primarily by blepharospasm and complicated by refractory persistent eyelid weakness that provide resistant to standard treatments. In contrast to typical approaches, we implemented a unique, tailored method that involved the precise micro-injection of botulinum toxin at the base of the eyelashes. An unusual clinical finding emerged: the patient experienced a complete cessation of spasms, both subjectively and objectively, within roughly 30 s after the injection. This rapid relief was temporarily stable during the immediate post-procedure observation period; the patient continued to enjoy lasting therapeutic benefits without any notable adverse effects during subsequent follow-ups. Importantly, this swift response cannot be explain by the usual mechanism of botulinum toxin’s neuromuscular blockade, which is known to require several days for its enzymatic effects to manifest. The micro-injection technique applied at the lash root addresses many drawbacks of conventional periorbital injections for patients with Meige syndrome who have pre-existing eyelid weakness. This method offers a long-lasting therapeutic effect with a reduced risk of damaging the levator palpebrae muscle and causing ptosis. The remarkable and rapid allevation of symptoms observed in this particular case is an unexpected clinical occurrence that should not be generalized as a standard characteristic of the injection technique. Various non-toxic agents with different mechanisms may account for the swift relief, necessitating further controlled studies with larger groups to differentiate between temporary procedural effects and the specific neuromuscular blockade caused by the toxin. This advanced micro-injection approach at the eyelash root successfully address the challenges of traditional methods, ensuring stable efficacy for Meige syndrome patients with ongoing eyelid weakness. It serves as a precise and tailored treatment option for certain Meige syndrome phenotypes, providing important insights for enhancing clinical treatment strategies, while the underlying biological explanation for rapid 30-second response remains to be comfirmed.