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Meige’s Syndrome Associated With Risperidone Therapy

To the Editor: Risperidone is an atypical antipsychotic that is effective for the positive, negative, and cognitive symptoms of schizophrenia (1). The incidence of extrapyramidal signs has been reported to be low during treatment with a dose of 6 mg/day. We report a case of Meige’s disease (2–4), an extrapyramidal syndrome that was secondary to risperidone treatment.

Mr. A was a 43-year-old, single Caucasian male who became psychiatrically ill at age 22 years and had since been taking various neuroleptics. From 1980 to 1996, he was prescribed thioridazine, 50 mg/day. More recently, his thioridazine therapy was changed to treatment with risperidone, 6 mg/day, as a result of an exacerbation of his symptoms. Mr. A then started blinking frequently. Sometime later, he noted episodic blepharospasms that either occurred spontaneously or were triggered by stress. As a result, he had to discontinue vision-dependent activities such as driving. More recently, he sought help for blepharospasms.

During an interview, Mr. A was noted to have intermittent blepharospasms that affected his vision. The more he tried to open his eyes, the more tightly his eyelids closed. He often struggled for about 3–5 minutes to open his eyes.

This patient had Meige’s disease that was secondary to his risperidone treatment. Because dopamine-2 blocking agents such as neuroleptics have been known to cause Meige’s disease (5), this finding is not surprising. In this case, tardive dystonia was ruled out because he had no other evidence of choreoathetotic movements elsewhere in his body. Spontaneous Meige’s disease was ruled out because of the absence of a family history of Parkinson’s disease, abnormal facial movements, and concomitant physical illnesses such as multiple sclerosis or autoimmune disorders. It is important to recognize this condition because the withdrawal of antipsychotic drugs may lead to a complete recovery from Meige’s disease.

REFERENCES

1. Marder SR, Meibach RC: Risperidone in the treatment of schizophrenia. Am J Psychiatry 1994; 151:825–835[Abstract/Free Full Text]
2. Meige H: Les convulsions de la face, une forme clinique de convulsion faciale, bilaterale et mediane. Rev Neurol (Paris) 1910; 20:437–443
3. Faulstich ME, Carnicke CLM, Williamson DA: Blepharospasm and Meige’s syndrome: a review of diagnostic, etiologic and treatment approaches. J Psychosom Res 1985; 29:89–94[Medline]
4. Jankovic J, Ford J: Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol 1983; 13:402–411[CrossRef][Medline]
5. Ananth J, Edelmuth E, Dargan B: Meige’s syndrome associated with neuroleptic treatment. Am J Psychiatry 1988; 145:513–515[Abstract/Free Full Text]

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