The Correlation between Blepharospasm and Psychological diseases: The Anxiety, Depression and Sleep disorder Study

Background: To investigate the relationship between Blepharospasm (BEB) symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with BoNT/A can impact psychological symptoms. Methods This prospective interventional case series recruited 61 adults with evidence of BEB. Patients were administered the Jankovic Rating Scale (JRS), the Blepharospasm Disability Index (BSDI), Personal Health Questionnaire Depression Scale (PHQ-8), Generalized Anxiety Disorder 7-item scale (GAD-7) and the Athens insomnia scale (AIS) to evaluate the severity of BEB symptoms, depression, anxiety and sleep disorder before and 1 week, 1 month, 3months after the BoNTA treatment. Statistical analysis was performed to assess the relationships between changes in the survey scores. Results The mean score for JRS, BSDI, PHQ-8, and GAD-7 improved significantly (P < 0.0001), respectively, compared to the initial visit at follow-up. At baseline, worse BSDI scores were correlated with worse GAD-7 and PHQ-8, but not with worse AIS. At 1 month follow-up visit, there is no correlation between change in BSDI and PHQ-8/AIS, the change in GAD-7 show a mild association with change in BSDI. The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety. Patient satisfaction with BoNT/A treatment reached the highest at one month of follow-up (83.6%, 51/61). Conclusions BEB may lead to psychological diseases, BoNT/A can significantly improve motor and non-motor symptoms of BEB, which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry. Trial registration: Clinicaltrials, NCT04939909. 2021/06/25, https://clinicaltrials.gov/ct2/show/NCT04939909