Sustained anxiolytic and antidepressant effects of botulinum toxin A in blepharospasm patients beyond motor symptom control.

BACKGROUND

The previous studies have primarily focused on the influence of botulinum toxin A (BoNT-A) injection on emotions during the period of peak motor symptom improvement in blepharospasm patients, based on facial feedback hypothesis.

AIM: To evaluate the sustained anxiolytic and antidepressant effects of BoNT-A in blepharospasm patients beyond motor symptom control.

METHODS

We recruited benign essential blepharospasm patients with BoNT-A treatment and collected their data to compare scale scores of Jankovic Rating Scale, Blepharospasm Disability Index, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Hamilton Anxiety Scale and Hamilton Depression Scale between pre-treatment (baseline) and pre-reinjection (treatment), to further assess the effects of repeated treatments with BoNT by using sub-group analyses in the certain special states.

RESULTS

A total of 21 eligible blepharospasm patients were with the mean age of 58.4 years and a male-to-female ratio of 1:6. Significantly decreases in the subscale scores of SDS and SAS, including SDS well-being index, decreased capacity and hard to decide, SAS inability to sit still and headache were showed at post-a single BoNT-A injection when scale scores of Jankovic Rating Scale and Blepharospasm Disability Index were matched between baseline and post-treatment. With each additional BoNT-A injection, the odds ratio of patients with the moderate depressive symptoms decreased by 92.6%. Moreover, BoNT treatment remained a decrease in the subscale scores of SDS and SAS in patients with repeated injections.

CONCLUSION

This study is to demonstrate that repeated BoNT-A injection have a long-lasting relief for anxiety and depressive symptoms in blepharospasm even after its motor symptom-modulating effects have diminished.