Meige's Syndrome: Rare Neurological Disorder Presenting as Conversion Disorder
A 35-year-old female presented to the Department of Psychiatry with complaints of sideways deviation of the jaw since one and half year. At the beginning, the deviation was 4-6 times a day and was not causing much difficulty for the patient. Gradually frequency increased and she developed chin thrusting movement. She also developed increased rate of blinking and these movements were very embarrassing to her. With a progressive course the severity of symptoms increased causing difficulty in sleep and problem in daily routine activities. She could voluntarily inhibit the symptoms to some extent.\nThe symptoms were precipitated with the emotional stressors, suggesting some secondary gain. No relevant past or family history of any medical or psychiatric illness was found. She was educated up to class fourth. Premorbid personality was well adjusted. Mental status examination shows she had anxious mood. There was no formal thought and perceptual disorder. She was well oriented, alert, had normal fluency, repetition and naming. Her attention, calculation and abstraction were absolutely normal. General physical exam was unremarkable. Neurological exam showed intact cranial nerve, coordination, motor and sensory fun normal. Ophthalmological exam showed no visual defect, absence of Kayser Fleischler ring. Hematological examination–Haemoglobin, Differential Count, Total Leukocyte Count etc., were normal. Blood sugar, Liver Function Test, Thyroid function test, Computed Tomography Scan and Magnetic Resonance Imaging was within normal limit. Psychological assessment that is chemical and verbal abreaction could not reveal anything. The patient was sent to the neurologist for opinion and diagnosed as a case of Meige's syndrome. She was prescribed Trihexyphenidyl and Clonazepam. There was a little improvement on next follow-up.