Efficacy of a combination of sodium valproate and baclofen in Meige's disease (idiopathic

Meige's disease is a bizarre, often disabling movement disorder of the elderly characterised by symmetric dystonic contractions of the orofacial muscles; at times other midline muscles such as the tongue and the palatopharyngeal, respiratory, and neck muscles may be affected.' 2 Although the spasms are often thought to be psychogenic in origin, there exists no convincing evidence that they represent a manifestation of a psychiatric disorder.' Similarly, there is little information on the pathophysiology of the disorder. Neophytides et al3 reported decreased cerebrospinal fluid y-aminobutyrate concentrations in patients with adult-onset dystonia. If this reflects a reduction in central y-aminobutyric-acid-mediated inhibition, the syndrome might result from a striatal dopaminergic predominance secondary to disinhibition of dopaminergic nigral neurons. Indeed, drugs with dopamine-receptor-blocking properties have been used, with limited success, for the dystonic spasms.4 We report a good clinical response in one case of Meige's disease treated with the yaminobutyric-acid-mimetic combination of sodium valproate and baclofen.