My mouth opens involuntarily. Is it normal

Dystonia - what is it?

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Dystonias are movement disorders that are caused in the brain. They express themselves through involuntary and persistent muscle tension, i.e. cramps that lead to unusual postures (e.g. of the head or the limbs) and uncontrollable movements (e.g. cramps of the eyelids). Important bodily functions such as seeing, speaking or eating can also be severely impaired. For those affected, this means that everyday activities become a challenge, which can be associated with severe restrictions in their private and professional life.

Dystonias are movement disorders that are caused in the brain.

They express themselves through involuntary and persistent muscle tension, i.e. cramps that lead to unusual postures (e.g. of the head or the limbs) and uncontrollable movements (e.g. cramps of the eyelids).

Important bodily functions such as seeing, speaking or eating can also be severely impaired. For those affected, this means that everyday activities become a challenge, which can be associated with severe restrictions in their private and professional life.

The name dystonia is derived from ancient Greek (dys-: "Bad" or "wrong"; tonos: "Tension") and means something like "faulty state of tension" of the muscles.

Not all dystonia is created equal

Dystonias appear in very different forms and forms.

Depending on which parts of the body are affected by the movement disorders, a distinction is made between the following groups:

  • Focal dystonias: Dystonia is limited to a single area of ​​the body, such as the neck, eyelid or jaw muscles. Within the focal dystonias one differentiates further subgroups or manifestations depending on the affected body region. Examples of this are cervical dystonia (or torticollis spasmodicus), in which the neck muscles are abnormally active and lead to a poor posture of the head, or blepharospasm, in which cramping of the eyelid closing muscles occurs, which leads to involuntary closing of the eyes.
  • Segmental dystonias: The dystonia is limited to two neighboring regions, e.g. B. face and jaw or arm and neck.
  • Multifocal dystonias: The dystonia affects two or more non-adjacent regions, e.g. B. face and arm or arm and leg.
  • Generalized dystonias: The dystonia extends to several non-adjacent regions, e.g. both legs or one leg and trunk and at least one other region of the body. This form of dystonia is less common and often associated with severe impairments and the need for care.
  • Hemidystonia: The extremities (arm and leg) on ​​one side of the body are affected.

Dystonia can occur at any age and affect anyone. About 80,000 cases of illness have been described in Germany, including 15,000 children and adolescents.

While the dystonias that set in in childhood often spread from one extremity to the entire body (generalize), the dystonias that appear for the first time in adulthood are usually limited to individual body regions (focal or segmental).

The symptoms of dystonia vary depending on which areas of the brain are affected and to which body region (s) the movement disorder is limited. Over 80% of dystonias that show up for the first time in adulthood belong to the group of focal or segmental dystonia.

Dystonias arise in the head without being a mental disorder

Even if dystonia manifests itself in a disorder of the musculoskeletal system, i.e. the muscles, the actually diseased organ is the brain. Dystonia is an organic neurological disease (impaired signal transmission from the brain to the muscles) that occurs in the so-called movement centers of the brain. These are the areas of the brain that control the activity of the muscles that are responsible for our unconscious movements (motor skills). In dystonia, this fine-tuning between the brain and muscle activity is disturbed. This leads to uncontrollable muscle spasms. Depending on which movement centers in the brain are affected, the movement disorder can encompass one or more parts of the body. It is not always known how the neurological disease occurs. With regard to the cause of dystonia, the following distinction is made:

  • Primary dystonias: Dystonia occurs regardless of an event or other illness. The cause is often unexplained (one then speaks of idiopathic dystonia).
  • Secondary dystonia: There is a cause (e.g. medication, injury to the brain). The cause of dystonia is linked to an event (e.g. a traumatic brain injury), a metabolic disorder or a neurological concomitant disease (e.g. Parkinson's disease). One then speaks of symptomatic dystonia.

Most are dystonias idiopathic, that is, its cause is unknown. In the most common cases, a combination of genetic and external factors is assumed to be the cause of the disease. Dystonia can be inherited, but it is not the norm. There are also carriers of a "dystonia gene" (21 different forms of this are already known) who do not suffer from dystonia.

Unfortunately, dystonias are often mistakenly perceived as a mental disorder by those affected and not taken seriously.

  1. brain
  2. signal
  3. Spinal cord
  4. Stimulus transmission
  5. nerve

On this website we would like to explain the most common forms of dystonia. First and foremost, these are dystonias from the group of focal and segmental dystonias, which mainly affect the muscles of the head, neck and extremities.

In the following you will first find an overview. If you select a dystonia, you will get to further information.

(Torticollis or torticollis spasmodicus)

Technical term: Cervical dystonia

Affected muscles: Throat and neck muscles

Features: Cervical means "belonging to the neck (cervix)". Depending on which muscles of the neck are affected, the cervical dystonia causes a rotation, sideways tilt, flexion or extension of the head / neck resulting in different shapes.

Form of dystonia: Focal dystonia

Symptoms

Torticollis or cervical dystonia is the umbrella term for a group of dystonias that affect the neck and neck muscles and lead to involuntary movements and poor posture in the neck, head and shoulder area. The movements can express themselves regularly (rhythmically) or irregularly. There are also those affected who have a stable bad posture.

In about half of those affected, an elevated shoulder position is observed in addition to the incorrect posture of the head and neck.

So-called "sensory tricks“(E.g. placing a finger on the cheek or the tip of the chin) lead to a temporary improvement in symptoms for the majority of those affected.

Manifestations

Depending on which muscles are affected and in which direction the incorrect posture of the head or neck is oriented, a distinction is made between simple forms of cervical dystonia (combinations are also possible):

Torticollis / Torticaput

The most common sub-form of cervical dystonia is the torticollis / torticaput. There is a vertical rotation of the neck or the head.

Collis comes from the Latin word collum for neck, caput stands for head. Depending on whether it is a misalignment of the neck or head, a distinction is made between the corresponding "Collis" or "Caput" position.

Laterocollis / Laterocaput

The Laterocollis / Laterocaput describes an inclination of the neck and the head in the direction of a shoulder.

Retrocollis / Retrocaput

The retrocollis / retrocaput describes a stretching movement of the neck or head backwards.

Anterocollis / Anterocaput

The anterocollis / anterocaput describes a forward bending of the neck or the head towards the chest.

Consequences for quality of life and side effects

The quality of life of people affected by cervical dystonia is sometimes severely impaired. Many everyday activities (e.g. driving a car) can only be carried out to a limited extent or not at all due to the poor posture. In addition, those affected often suffer from ignorance and stigmatization of their symptoms (signs of illness) by their environment.

A stigma (Greek for "wound") is a prominent feature that apparently distinguishes a person from others - and on the basis of which unjustified conclusions can be drawn about their overall character.

As Stigma a process in society is referred to in which people are assigned a certain status based on a (usually negative) characteristic. Stigmatization often culminates in social discrimination.

In addition to the movement disorder caused by dystonia, those affected often suffer from pain. Signs of wear and tear of the cervical spine and nerve entrapment can occur as a result of the disease.

It is not surprising that the loss of quality of life in those affected is associated with social withdrawal and decreased self-esteem. It is not uncommon for mental illnesses such as depression or anxiety to develop from this.

frequency

In Germany around 20 inhabitants out of 100,000 are affected. Cervical dystonia often first manifests itself around the age of 40. It can develop suddenly (“overnight”) or slowly and progressively over a period of a few months. Neck tension or head tremors are often the initial symptoms before the misalignment of the head is noticeable.

root cause

The cause of the development of cervical dystonia has not yet been clarified (idiopathic Dystonia). A disorder is suspected in the area of ​​the basal ganglia, i.e. in certain areas of the brain that play an important role in the control of movement sequences. There is also evidence that genetic factors play a role.

Out of ignorance, cervical dystonia is repeatedly mistakenly presented as a mental illness, although it has been proven to be an organic illness.

Diagnosis and therapy

The decisive factor for the diagnosis of cervical dystonia is the recognition of the typical incorrect posture or movement pattern.

In a very small number of people (5%), torticollis is the secondary symptom of another disease. Additional neurological symptoms such as paralysis, uncoordinated movements, attention and memory disorders indicate this case.

The goals of treating cervical dystonia are:

  • Functional improvement in activities of daily living
  • Reduction of pain and stigma

There are various therapy options, e.g. oral medication, physiotherapy, surgical interventions and others. According to the current state of knowledge, the injection of botulinum toxin is the treatment of choice for cervical dystonia. Other therapy options are usually only used if the treatment with botulinum toxin was unsatisfactory.

The majority of patients with cervical dystonia benefit very well from botulinum toxin therapy. The improvement that can be achieved affects both poor posture and involuntary movements and pain symptoms. As the muscle-relaxing effect of the active ingredient is only temporary, the treatment must be repeated at regular intervals.

Some forms of cervical dystonia may be less responsive to botulinum toxin treatment. Furthermore, it is possible that the pain results from a longer previous damage to the cervical spine and so the muscular treatment alone does not improve the pain.

More about treatment with botulinum toxin

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Cervical dystonia is incurable, but in 60 to 90% of cases the disease can be successfully treated by injecting botulinum toxin.

When dealing with the stigmatization that can occur due to the illness, self-help groups can make a decisive contribution - you can find an overview under Links & Addresses.

Patient with torticollis

Treatment of a patient with torticollis by Prof. Dr. Wolfgang Jost, specialist in neurology, expert in movement disorders and long-time botulinum toxin user.

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Blepharospasm

(Eyelid cramp)

Technical term: Blepharospasm

Affected muscles: Eyelid closing muscles

Features:Blepharospasm means "cramp (spasm) of the eyelid (blepharon) ". Dystonia causes involuntary cramping of the eyelid, which leads to impaired vision.

Form of dystonia: Focal dystonia

Symptoms

The term blepharospasm comes from the Greek and translates as: eyelid cramp. It is a dystonia of the eyelid closing muscles, which leads to an uncontrollable closing of the eyes over shorter or longer periods of time.

In its early stages, the disease can hardly be distinguished from an ordinary wink. Over time, however, the blinking takes on convulsive forms, so that in the end the eyes can hardly be kept open.

For those affected, it is less the cramping that is in the foreground than the loss of vision that results from the no longer controllable opening or keeping the eyes open. Blepharospasm in an advanced stage can lead to functional blindness.

Blepharospasm is usually bilateral, but it can be more pronounced on one side than the other.

Poor lighting, drafts, reading, and physical activity can worsen symptoms, while mental and physical relaxation can help.

Consequences for the quality of life

Blepharospasm can lead to major restrictions in many everyday activities (e.g. reading, driving, watching TV, or doing household chores). Those affected are often dependent on an accompanying person when they want to leave the house and, among other things, safely participate in road traffic. It is not surprising that the physical limitations and lack of understanding that many of those affected lead to increased social withdrawal. The quality of life suffers greatly from the consequences of the disease and its stigmatization.

A stigma (Greek for "wound") is a prominent feature that apparently distinguishes a person from others - and on the basis of which unjustified conclusions can be drawn about their overall character.

As Stigma a process in society is referred to in which people are assigned a certain status based on a (usually negative) characteristic. Stigmatization often culminates in social discrimination.

frequency

Blepharospasm is a rare disease (there are 10 people out of about 10,000 people). Due to this fact, the diagnosis is not made right by every doctor right away.

Blepharospasm occurs predominantly in people in the second half of life. Women are affected slightly more often than men.

causes

The exact cause of blepharospasm is unknown (idiopathic Dystonia). We know that there is a disorder in the brain (more precisely: in the area of ​​the basal ganglia) and that several biochemical substances are probably involved. However, details are unknown.

Although it has been clarified that this is an organic disease, dependencies on external influences and mental well-being are also described. Those affected regularly report that they have more complaints from stress and anger. If they lie down and rest or do certain activities (e.g. ironing or unusual movements such as walking backwards), those affected can be symptom-free or symptom-free. In most cases, the complaints are less severe even on vacation.

Diagnosis and therapy

The diagnosis is usually made by the neurologist. The ophthalmologist does not always notice blepharospasm as the cause of the symptoms, since eyelid cramps also occur in other contexts (e.g. with inflammation of the outer eye or when patients are examined with brightly shining instruments).

If you notice any signs of blepharospasm, it is better to have the findings checked by a neurologist. Your eye doctor may not be able to diagnose the condition.

The goals of treating blepharospasm are:

  • Improve visual function
  • Reduce stigma

Injection of botulinum toxin is the treatment of choice for blepharospasm. Alternative medication or other treatments are only considered if the treatment with botulinum toxin does not work.

Botulinum toxin is injected into the eyelids and / or areas outside the eye socket and is usually not painful because very fine needles are used.

Most of the patients treated benefit from treatment with botulinum toxin. Since the active ingredient's muscle-relaxing effect is temporary, the treatment must be repeated at regular intervals.

More common side effects after the injection are eyelid dots (drooping eyelids) and dry eyes. These side effects are temporary.

Therapy with botulinum toxin can be carried out by ophthalmologists, neurologists and ear, nose and throat specialists (possibly also by other specialist doctors).

There are now treatment centers that specialize in the therapy of blepharospasm. Further information is available from the German Dystonia Society.

More about treatment with botulinum toxin

More

When dealing with stigmatization as a result of the illness, self-help groups can make a decisive contribution. You can find an overview under Links & Addresses.

Patient with eyelid cramps

Treatment of a patient with eyelid cramps by Prof. Dr. Wolfgang Jost, specialist in neurology, expert in movement disorders and long-time botulinum toxin user.

Patient with eyelid cramps

Treatment of a patient with eyelid cramps by Prof. Dr. Wolfgang Jost, specialist in neurology, expert in movement disorders and long-time botulinum toxin user.

Back to the overview of the manifestations

Laryngeal dystonia

(Vocal cord spasm)

Technical term: Laryngeal dystonia

Other names: Spasmodic dysphonia ("voice stutter")

Affected muscles: Larynx muscles

Features:Laryngeal means in medical terminology "the larynx (larynx) concerning". It is a dystonia of the internal muscles of the larynx that leads to excruciating speech disorders.

Form of dystonia: Focal dystonia

Symptoms

The language of those affected is characterized by:

  • Dropouts
  • Pressed sounds when the muscles of the larynx, neck, face and respiratory muscles are tense or
  • a breathy whisper voice

The movements of the face and neck also lead to distortions and distortions of facial features and head posture when speaking.

Manifestations

There are two types of laryngeal dystonia:

  • Adductor type: The voice sounds tight and people try to speak as they inhale. Voices can be dropped.
  • Abductor type: Those affected speak in a breathy, whispered voice, which is associated with a lot of air consumption.

The naming of the two subforms refers to the respective affected muscle group of the larynx (adductors: "pulling muscles" that cause the vocal folds to close for vocal production; abductors: "away muscles" that cause the vocal folds to open for breathing). The adductor form of laryngeal dystonia is much more common than the abductor form.

Position on voice training

 

  1. Musculature
  2. vocal cords

For voice training, the vocal cords are tensed and almost closed. The air flowing out sets them vibrating and sound waves are created.

At the Adductor type the muscles cramp when the vocal folds are closed, i.e. in the position in which the voice is formed. The voices of those affected are tense, groaning, their voices sound pressed and laborious. Stronger cramps are expressed by broken voices. Accordingly, speaking causes great difficulties for those affected. In the most severe cases, voice failure occurs.

Airway position

  1. Epiglottis
  2. windpipe

At the Abductor type muscle spasms occur when the vocal cords are open, i.e. in the position in which air enters the windpipe for breathing. Those affected speak in a breathy whisper.

A special feature of both forms of laryngeal dystonia is that the voice can be completely normal when laughing and crying. When singing and quoting verses, the voice is usually much better, on the other hand, the symptoms can be aggravated when stressed and especially when making calls.

Consequences for quality of life and side effects

Depending on the severity of the disease, laryngeal dystonia leads to slight restrictions in speaking, which are manifested in a temporary "stagnation" of the voice and interruptions in the flow of speech, up to complete loss of voice. Verbal communication turns out to be difficult for those affected and, in severe cases, impossible. The consequences are not infrequently a social withdrawal, which results from the limited participation in social life, and the inability to work.

causes

The causes of laryngeal dystonia are still unexplained (idiopathic Dystonia) and are discussed controversially, even if we know comparatively more than we did 10 years ago.

For a long time, the clinical picture was considered to be a psychologically induced voice disorder: as a neurotic manifestation of a deeply rooted emotional conflict. However, recent research suggests that in many of those affected there is an organic cause of the movement disorder of the larynx muscles in the central nervous system. Any previous emotional trauma will continue to be interpreted as a conceivable triggering factor, but no longer as a causal factor. In a small group of people affected, there are initial indications of a genetic - and thus also hereditary cause (a genetic defect on chromosome 9). In these cases there is a noticeable familial accumulation of illnesses.

In rare cases there is also acquired secondary laryngeal dystonia, e.g. after cranial brain injuries, tumors, carbon monoxide poisoning or after prolonged use of certain medications (especially neuroleptics). In the case of secondary laryngeal dystonia, damage in the brain (in the area of ​​the basal ganglia) was found in many cases.

Diagnosis and therapy

The tone of the voice of those affected is so characteristic that the phoniatrist (the specialist in medical voice disorders) can usually make the suspected diagnosis after a conversation with the affected person.

If the characteristic speech disorders are accompanied by other neurological symptoms such as weak reflexes, seizures or paralysis, this is a sign that an underlying neurological disease other than idiopathic laryngeal dystonia is present. In this case one speaks of secondary or symptomatic laryngeal dystonia.

Laryngeal dystonia is a rare disease and the general practitioner or internist is only aware of this clinical picture in exceptional cases; even ENT doctors are not necessarily familiar with the disease; it is not even mentioned in some textbooks. If you notice the symptoms of laryngeal dystonia, have the disease clarified by a specialist (phoniatrist or neurologist).

The goal of treatment for laryngeal dystonia is to restore speech.

The therapy of choice for this is the injection of the muscle-relaxing agent botulinum toxin. The attending physician can inject the medication either through the skin of the neck (transcutaneously: "through the skin") or through the mouth (transorally).

The overactivity of the treated larynx muscles is already reduced after a few days due to the action of botulinum toxin. However, as the effects wear off over time, the injection must be repeated at regular intervals.

Immediately after the injection, small amounts of fluid can enter the airways (swallowing), a feeling of tightness in the larynx and voice weakness. These side effects are temporary.

More about treatment with botulinum toxin

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Speech therapy in combination with psychosomatic support represents an alternative treatment approach. However, this approach offers little chance of success for those affected with pronounced symptoms.

In particularly severe cases, an operation to alleviate the symptoms is an option, e.g. the unilateral severing of the recurrent nerve that supplies the vocal lip muscle.

Back to the overview of the manifestations

Oromandibular dystonia

(Cramp in the mouth, tongue and throat)

Technical term: Oromandibular dystonia

Affected muscles: Lower jaw, mouth and tongue muscles (muscles of the lower half of the face)

Features: Oromandibular means "relating to the mouth (oris) and lower jaw (mandible)". Dystonia leads to involuntary tongue and chewing movements.

Form of dystonia: Focal dystonia

Symptoms

Oromandibular dystonia (OMD) results in uncontrolled spasms of the jaw, mouth and tongue muscles.

That leads to:

  • Grimacing through cramps in the facial muscles
  • Involuntary tongue movements that affect eating and speaking
  • Uncontrolled jaw and chewing movements

Three different muscle groups are affected by the cramps. First of all, the mimic muscles should be mentioned, i.e. the muscles that provide facial expression. Oromandibular dystonia causes involuntary tension in the facial muscles in the mouth and neck area, which distorts the facial expression like a grimace.

The second group are the mandibular or mastication muscles. These are responsible for the vigorous biting and the grinding chewing movement. There are two different types of OMD, depending on whether the cramps occur when the jaw is opened or closed.

The third muscle group forms the tongue and throat muscles. With OMD, the tongue can move continuously in all directions. If it is particularly strong, speaking and swallowing can become completely impossible for those affected. Abnormal movements of the throat become noticeable, for example, as a "lump feeling" or through frequent swallowing.

The symptoms of oromandibular dystonia increase with stress and emotional tension. On the other hand, they decrease during rest and relaxation and disappear completely during sleep. Active movements of the affected muscles, e.g. when speaking, increase the symptoms.

Consequences for quality of life and side effects

As a result of the uncontrolled movements of the tongue and masticatory muscles, it can

  • Bite injuries
  • Tooth output and tooth bridges
  • Jaw dislocations and
  • Pain in muscles and temporomandibular joints

come. In addition, those affected are impaired in their everyday life as well as in social terms by the complaints when eating and speaking. Often they suffer from the lack of understanding and the stigmatization of their symptoms by their ignorant environment.

A stigma (Greek for "wound") is a prominent feature that apparently distinguishes a person from others - and on the basis of which unjustified conclusions can be drawn about their overall character.

As Stigma a process in society is referred to in which people are assigned a certain status based on a (usually negative) characteristic. Stigmatization often culminates in social discrimination.

root cause

The cause of oromandibular dystonia is ultimately still unclear (idiopathic Dystonia). However, there are indications of an organically caused malfunction of movement control in the brain.

Psychological factors (such as stress) influence the occurrence and severity of the dystonic movements, but are not to be regarded as their cause. About 20% of patients have a cause such as B. damage to the movement centers through previous head injuries, stroke or the use of neuroleptics (secondary dystonia). About 70% of all patients with oromandibular dystonia are women. The average age at the onset of the disease is 44 years. The symptoms can increase continuously over the years.

Diagnosis and therapy

As with other dystonias, the diagnosis is based on a thorough clinical examination by a specialist doctor, usually a neurologist. Unfortunately, the diagnosis is sometimes only recognized after a long odyssey from doctor to doctor. This is because other movement disorders are similar to and can be confused with symptoms of oromandibular dystonia. Often, for example, due to the tense mastication muscles, bruxism (nocturnal teeth grinding) or an overload of the temporomandibular joint are initially considered. In old age and with toothlessness, sometimes involuntary movements of the mouth region occur without oromandibular dystonia. Also need facial tics and the one-sided Hemifacial spasm can be distinguished from oromandibular dystonia.

The symptoms of oromandibular dystonia are often confused with other movement disorders, which makes diagnosis difficult.

If you notice any signs of the disease, it is best to have them clarified by a specialist neurologist.

The goals of treatment are:

  • Reduction and prevention of bite injuries, damage to the tooth area and jaw dislocations
  • Reduction of pain in muscles and temporomandibular joints
  • Improving food intake and speaking
  • Cosmetic improvements
  • Reduction of stigmata

One possibility to achieve the intended therapy goals is therapy with botulinum toxin. It is a muscle-relaxing drug that is injected directly into the muscles involved. As the effect wears off over time, the treatment must be repeated at regular intervals.

More about treatment with botulinum toxin

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Therapy with botulinum toxin can improve movement disorders in up to 60% of cases. Depending on the appearance of the disease, it may take longer to find the optimal dose and regimen for injection treatment. In such cases, it is important to remain patient and optimistic through the initial treatment.

Oral medications are also a way of treating oromandibular dystonias. Since their effect is not limited to the muscles involved, they are sometimes associated with considerable side effects. Further treatment options are surgical measures, speech therapy and physiotherapy exercises. If you have difficulty swallowing, nutritional advice can also be helpful. Often those affected benefit from a combination of the therapy methods mentioned.

More about the therapy options

For severely affected patients, feeding tubes or a speech computer can be useful aids. The use of speech computers is particularly appropriate if there is also hand dystonia.

Back to the overview of the manifestations

Meige syndrome

Technical term: Meige syndrome

Other names: Idiopathic orofacial dyskinesia, blepharospasm-oromandibular dystonia, Brueghel syndrome

Affected muscles: Eyelid closure, jaw, mouth and tongue muscles

Features: It is a combination of blepharospasm (eyelid spasm) and oromandibular dystonia, which was described in 1910 by the ophthalmologist Henry Meige.

Form of dystonia: Segmental dystonia

Symptoms

Meige syndrome causes uncontrolled spasms of the eyelid, jaw, mouth and tongue muscles. That leads to:

  • Impairment of visual function due to eyelid cramps
  • Grimacing through cramps in the facial muscles
  • Involuntary tongue movements that affect eating and speaking
  • Uncontrolled jaw and chewing movements

The symptoms of Meige syndrome are a combination of the symptoms of blepharospasm and oromandibular dystonia.

For more information see:

Consequences for quality of life and side effects

The eyelid cramps can lead to major restrictions in many everyday activities (e.g. reading, driving a car, watching TV or doing household chores). Those affected are often dependent on an accompanying person when they want to leave the house and, among other things, safely participate in road traffic. In addition, those affected suffer from possible consequences of Meige syndrome such as:

  • Bite injuries
  • Tooth abrasion and dental bridges
  • Dislocated jaws
  • Pain in muscles and temporomandibular joints
  • Discomfort when eating and speaking
  • Stigmatization of movement disorders

It is not surprising that the physical limitations and lack of understanding that many of those affected have towards their surroundings are increasingly leading to social withdrawal. The quality of life suffers greatly from the consequences of the disease and its stigmatization.

A stigma (Greek for "wound") is a prominent feature that apparently distinguishes a person from others - and on the basis of which unjustified conclusions can be drawn about their overall character.

As Stigma a process in society is referred to in which people are assigned a certain status based on a (usually negative) characteristic. Stigmatization often culminates in social discrimination.

root cause

The cause of Meige syndrome is ultimately still unclear (idiopathic Dystonia). However, there are indications of an organically caused malfunction of movement control in the brain.

Psychological factors (such as stress) influence the occurrence and severity of the dystonic movements, but are not to be regarded as their cause.

Diagnosis and therapy

The diagnosis is usually made by the neurologist. Due to the special combination of symptoms in the eye, jaw, mouth and tongue region, the diagnosis of Meige syndrome is easier than with some other dystonias. The goals of treatment are:

  • Improve visual function
  • Reduction and prevention of bite injuries, damage to the tooth area and jaw dislocations
  • Reduction of pain in muscles and temporomandibular joints
  • Improving food intake and speaking
  • Cosmetic improvements
  • Reduction of stigmata

For more information: