Advances in the treatment of Meige syndrome

Meige syndrome is a form of segmental craniofacial dystonia characterized predominantly by blepharospasm and frequently accompanied by oromandibular and lower facial dystonia. It is associated with substantial symptom burden, considerable clinical heterogeneity, and persistent challenges in long-term management, including marked variability in treatment response, fragmented evidence, and the absence of standardized stratified therapeutic approaches. Against this background, this Review aims to provide a comprehensive and critical update on current therapeutic advances in Meige syndrome. First, we focus on the major established treatment modalities, including botulinum toxin therapy—with particular attention to formulation selection, dose optimization, injection strategies, safety, and efficacy assessment—systemic pharmacotherapy, including its appropriate clinical indications, potential benefits, and inherent limitations, and deep brain stimulation (DBS) for refractory cases, with emphasis on clinical efficacy, safety, target selection, and parameter optimization. In parallel, we discuss how objective tools such as neuroimaging and electrophysiological techniques may help clarify the associations between specific therapeutic strategies and disease subtypes, symptom profiles, and clinical outcomes. Second, we summarize the available evidence for adjunctive or alternative interventions, including acupuncture, radiofrequency-based approaches, and transcranial magnetic stimulation, in order to present a more complete picture of the therapeutic landscape in Meige syndrome. Finally, we highlight the translational potential of neuromodulatory strategies in this disorder, particularly their prospective role in improving refractory symptoms, refining individualized treatment pathways, and advancing precision-based management. By integrating evidence across these domains, we aim to provide a clearer framework for clinical decision-making in Meige syndrome, while identifying key gaps in the current literature and informing future efforts toward standardized outcome measures, prospective study design, and the development of novel neuromodulatory therapies.