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Year : 2011  |  Volume : 14  |  Issue : 2  |  Page : 133-134

Tardive Meige's syndrome associated with olanzapine

1 Department of Psychiatry, Indira Gandhi Medical College, Shimla, India
2 Dr RML Hospital, New Delhi, India
3 GB Pant Hospital, New Delhi, India

Date of Submission20-Nov-2009
Date of Decision20-Jul-2010
Date of Acceptance26-Jul-2010
Date of Web Publication7-Jul-2011

Correspondence Address:
Ashish Aggarwal
Department of Psychiatry, Indira Gandhi Medical College, Shimla - 171 001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-2327.82808

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Meige's syndrome is characterized by blepharospasm and oromandibular dystonia. It has been reported as a complication of typical antipsychotics. To the best of our knowledge, case of olanzapine-induced tardive Meige's syndrome has not been reported in the literature. We we are reporting report a case of Meige's syndrome developing after long term therapy with olanzapine.

Keywords: Meige′s syndrome, olanzapine, tardive

How to cite this article:
Aggarwal A, Jain M, Khandelwal A, Jiloha R C. Tardive Meige's syndrome associated with olanzapine. Ann Indian Acad Neurol 2011;14:133-4

How to cite this URL:
Aggarwal A, Jain M, Khandelwal A, Jiloha R C. Tardive Meige's syndrome associated with olanzapine. Ann Indian Acad Neurol [serial online] 2011 [cited 2021 Mar 6];14:133-4. Available from:

   Introduction Top

Meige's syndrome was first described in 1910 by Meige as a syndrome of idiopathic blepharospasm and oromandibular dystonia. [1] The syndrome is especially distressing because of bilateral involvement of orbicularis muscles resulting in difficulty in opening eyes. Meige's syndrome developing after long term first generation antipsychotics has been described. [2],[3] Literature search revealed only few cases of Meige's syndrome secondary to newer second generation antipsychotics. [4],[5],[6] These have been generally reported to be acute in onset. We are reporting a case of Tardive Meige's syndrome secondary to olanzapine therapy, which to the best of our knowledge has not been reported so far in the literature.

   Case Report Top

A 30-year-old married female was suffering from schizophrenia (DSM IV TR criteria) for the last 4 years. Her past, personal, and family histories were not significant. She was prescribed olanzapine 5 mg, which was increased to 15 mg per day after about 1 year of start of illness. She did not receive any treatment prior to olanzapine. Lorazepam was prescribed initially for a period of 2 weeks, which was later on tapered and withdrawn. She improved markedly with treatment. She presented to us in follow-up on the same dose of olanzapine with complaints of intermittent inability to open her both eyes and abnormal movements involving the mandibular and neck regions. These started after about 3 years of regular treatment with olanzapine. The compliance to therapy was adequately ensured by the family members. She reported difficulty in speaking and eating when she would have these abnormal movements. These would also hamper her vision-dependent activities like watching television and cooking food. A diagnosis of blepharospasm and oromandibular dystonia was made. There were no other abnormal movements in any of the body parts. Results from a physical examination revealed that she had an irregularly repetitive blepharospasm together with spasms in which the jaw opened up and of the neck. Magnetic resonance imaging (brain), routine blood analysis, thyroid function test, EEG, and ceruloplasmin levels were all normal. Subsequently, a diagnosis of tardive Meige's syndrome was made. Naranjo Adverse drug reaction scale [7] indicated a probable relationship with olanzapine, with a score of 6. Subsequently, olanzapine was stopped and patient was started on clozapine, which was increased to 100 mg per day. She reported improvement in her abnormal movements after about 3 month of therapy without any relapse of psychotic symptoms and has been maintaining well for the next 6 months of follow-up without any relapse of psychotic symptoms or movement disorder.

   Discussion Top

To our knowledge, this is the first report describing tardive Meige's syndrome associated with olanzapine therapy. Previous report was of acute Meige's syndrome with olanzapine. [4]

Besides idiopathic Meige's syndrome, there are various secondary causes of Meige's syndrome, which are further suggested by pharmacological studies indicating central dopaminergic preponderance as a possible biochemical basis for this syndrome. [8],[9] This hypothesis is further supported by observation of improvement with the dopamine-depleting agent tetrabenazine. [10]

Olanzapine has Dopamine D2 receptor occupancy higher than that of clozapine or quetiapine and similar to that of risperidone, [11] which may have accounted for the development of Meige's syndrome, which is generally regarded as a possible variant of tardive dyskinesia. The possibility that Meige's syndrome can be induced by long-term neuroleptic treatment suggests that a similar pathophysiological mechanism may play a role in both the drug-induced and idiopathic forms of this disorder. Dopaminergic supersensitivity may contribute to this pathophysiological mechanism.

The temporal relation between long term olanzapine administration, the appearance of characteristic dystonic reaction in the absence of choreoathetotic movements, the prompt response to olanzapine withdrawal and clozapine administration and young age at onset as compared to idiopathic Meige syndrome can easily rule out idiopathic Meige's syndrome. [12] One can argue that the remission of Meige's syndrome was due to simple withdrawal of olanzapine, but clozapine was started because of risk of psychotic relapse and also because it has been shown to play significant role in the management of this syndrome. [13],[14] There have been recent reports of olanzapine-induced tardive dyskinesia and dystonia. [15],[16] Contrary to this, few reports also suggest the role of olanzapine for the management of these tardive movements induced by other antipsychotics. [17],[18]

This report suggests that Meige's syndrome can occur even with atypical antipsychotics as a tardive side effect.

Our report suggests that one can develop this disabling syndrome even with newer antipsychotics and close monitoring of patients and early warning to be given to the patients is warranted. More research on long term data on safety of newer antipsychotics is warranted.

   References Top

1.Meige H. Les convulsion de la face, une forme clinique de convulsion faciale, bilateral et mediane. Rev Neurol (Paris)1910;10:437-43.  Back to cited text no. 1
2.Kurata K, Yuasa S, Kazukawa S, Kurachi M, Fukuda T. Meige's syndrome during long-term neuroleptic treatment. Jpn J Psychiatry Neurol 1989;43:627-31.  Back to cited text no. 2
3.Bogdanov I, Sirota P. Meige's syndrome associated with neuroleptic treatment and alcohol abuse. Int J Psych Clin Pract 2003;7:49-51.  Back to cited text no. 3
4.Mendhekar DN, War L. Olanzapine induced acute Meige's syndrome. J Neuropsychiatry Clin Neurosci 2009;21:225.  Back to cited text no. 4
5.Ananth J, Burgoyne K, Aquino S. Meig's syndrome associated with risperidone therapy. Am J Psychiatry 2000;157:149.  Back to cited text no. 5
6.Nishikawa T, Nishioka S. A case of Meige dystonia induced by short-term quetiapine treatment. Hum Psychopharmacol 2002;17:197.  Back to cited text no. 6
7.Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.  Back to cited text no. 7
8.Gollomp S, Illson J, Burke R, Reches A, Fahn S et al. Meige syndrome: A review of 31 cases. Neurology 1981;31:A78.  Back to cited text no. 8
9.Tolosa ES, Lai C. Meige disease: Striatal dopaminergic preponderance. Neurology 1979;29:1126-30.  Back to cited text no. 9
10.Jankovic J. Treatment of hyperkinetic movement disorders with tetrabenazine: A double-blind crossover study. Ann Neurol 1982;11:41-7.  Back to cited text no. 10
11.Kapur S, Zipursky RB, Remington G, Jones C, DaSilva J, Wilson AA, et al. 5-HT2 and D2 receptor occupancy of olanzapine in schizophrenia: A PET investigation. Am J Psychiatry 1998;155:921-8.   Back to cited text no. 11
12.Ananth J, Edelmuth E, Dargan B. Meige syndrome associated with neuroleptic treatment. Am J Psychiatry 1988;145:513-4.  Back to cited text no. 12
13.Sieche A, Giedke H. Treatment of primary cranial dystonia (Meige's syndrome) with clozapine. J Clin Psychiatry 2000;61:949.   Back to cited text no. 13
14.Van Putten T, Wirshing WC, Marder SR. Tardive Meige syndrome responsive to clozapine. J Clin Psychopharmacol 1990;10:381-2.   Back to cited text no. 14
15.Bella VL, Piccoli F. Olanzepine-induced tardive dyskinesia. Br J Psychiatry 2003;182:81-2.   Back to cited text no. 15
16.Aggarwal A, Jiloha RC. Olanzapine induced tardive dystonia. Indian J Pharmacol 2008;40:237-8.  Back to cited text no. 16
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17.Fukui H. Marked improvement of Meig's syndrome with olanzapine in a schizophrenic patient. J Neuropsychiatry Clin Neurosci 2002;14:355-6.  Back to cited text no. 17
18.Jaffe ME, Simpson GM. Reduction of tardive dystonia with olanzapine (letter). Am J Psychiatry 1999;156:2016.  Back to cited text no. 18

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