Depression in blepharospasm: a question of facial feedback?

Abstract

Depression is the most important nonmotor symptom in blepharospasm (BL). As facial expression influences emotional perception, summarized as the facial feedback hypothesis, we investigated if patients report fewer depressive symptoms if injections of botulinum neurotoxin (BoNT) include the “grief muscles” of the glabellar region, compared to treatment of orbicularis oculi muscles alone. Ninety BL patients were included, half of whom had BoNT treatment including the frown lines. While treatment pattern did not predict depressive symptoms overall, subgroup analysis revealed that in male BL patients, BoNT injections into the frown lines were associated with remarkably less depressive symptoms. We hypothesize that in BL patients presenting with dystonia of the eyebrow region, BoNT therapy should include frown line application whenever justified, to optimize nonmotor effects of BoNT denervation.

The Prevalence and Correlation of Non-motor Symptoms in Adult Patients with Idiopathic Focal or Segmental Dystonia

“…Among patients with blepharospasm, some authors have suggested that depression may be a cause of the facial feedback. 37 …”

Postmarketing safety surveillance data reveals antidepressant effects of botulinum toxin across various indications and injection sites

“…Accordingly, its paralysis in the cosmetic treatment of crow's feet wrinkles by injection of BoNT has been associated with increased depression scores 57 . On the other hand, depression associated with blepharospasm is relieved if the affected muscles are injected with BoNT, and the antidepressant effect may be more pronounced if the treatment involves the glabellar region 58,59 .…”

Botulinumtoxin in der Augenheilkunde

“…Viele der Patienten wurden früher und werden z. T. heute noch fälschlicherweise für psychisch krank gehalten, jedoch handelt es sich beim essenziellen Blepharospasmus um eine zwar seltene (etwa 1 : 10 000), aber eindeutig organische Ursache. Reaktive Begleitsymptome wie Schlafstörungen, depressive Symptome und Störungen der Sexualfunktionen können allerdings durchaus auftreten [1,2].…”

“…Neuere Skalen messen auch die psychosozialen Probleme der Patienten und ermöglichen damit eine verbesserte Therapieoptimierung [5]. Die Therapie mit Botulinumtoxin scheint sich auch günstig auf die bei vielen Patienten mit essenziellem Blepharospasmus bestehenden depressiven Symptome auszuwirken [1]. Nur etwa 5 % der Patienten sprechen auch nach Modifikation des Therapieschemas nicht ausreichend auf die Botulinumtoxin-Injektionen an.…”