Meige Syndrome Following COVID Infection

A 61-year-old woman known for prediabetes and dyslipidemia was referred by her optometrist to our neurology clinic for blepharospasm.Her past neurological history was unremarkable, and she was not previously exposed to dopamine-depleting agents.She had received three prior doses of COVID vaccination.Her symptoms began 7 days after the first episode of an asymptomatic COVID infection confirmed by molecular testing.This evolved over a period of 2 to 3 months into functional blindness from blepharospasm and speech difficulties due to oral and facial dystonia (video 1, segment 1). There initially was no implication of cervical or axial musculature, but 5 months after the initial presentation, the patient also developed mandibular, cervical, and vocal cord dystonia (video 1, segment 2).This constellation of symptoms led to social isolation, depressive symptoms, and professional disability.A thorough workup was performed, including complete blood count and differential, serum protein electrophoresis, electrolytes, renal function, hepatic function, vitamin B 12 , C-reactive protein, TSH, anti-TPO, anti-B2-glycoprotein, IgA, anti-gliadin, anti-Sm, anti-RNP, anti-SSA, anti-SSB, and anti-scl 70, and Tropheryma whipplei polymerase chain reaction, which were negative.A normal magnetic resonance imaging excluded structural or vascular lesions.Botulinum therapy injections were initiated with partial success after four cycles.As an adjunctive treatment, a trial of clonazepam produced suboptimal benefit, which was followed by another trial of zolpidem that was later stopped by the patient for lack of benefit.Tetrabenazine was contraindicated due to severe depressive symptoms, and Trihexyphenidyl was refused by the patient due to its side-effect profile.Meige syndrome is a rare movement disorder characterized by blepharospasm and oromandibular dystonia.1,2 This focal dystonia typically presents in middle-aged women and is usually idiopathic.Secondary forms exist following dopamine-blocker use or with structural lesions such as strokes, tumors, or demyelination of various brain regions such as the brain stem, 1,3 and the thalamus.1,3 Some authors report anomalies involving the basal ganglia, the cerebellum, and the midbrain.3 This syndrome has also been described as a component of other movement disorders such as Parkinson's disease, 1,2 Huntington's disease, 1,2 olivopontocerebellar atrophy, 1 or Lewy body disease. 1 Botulinum toxin injections are

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