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

Table 1 Demographic and clinical characteristics of eligible patients at baseline, n (%)/mean ± SD

	Patients (n = 21)
Age, years	58.4 ± 9.5
Sex (female)	18 (85.7)
Education
Less than high school	14 (66.7)
High school	4 (19.1)
Bachelor or higher	3 (14.3)
Age at onset (years)	50.8 ± 9.5
Frequency of BoNT-A injection	9.3 (7.6)
Endpoint of evaluation (weeks)	23.4 ± 6.1
Assessment of anxious symptoms
SAS total score (median, IQR)	30.0 (25.5, 35.5)
Anxiety and panic	5.0 (5.0, 7.5)
Somatic control	6.0 (5.0, 8.0)
Vestibular sensations	5.0 (5.0, 5.5)
Gastrointestinal/muscular sensations	6.0 (5.0, 8.0)
HAMA (median, IQR)	2.0 (0, 3.5)
Assessment of depressive symptoms
SDS total score (median, IQR)	30.0 (25.0, 34.0)
Well-being index	5.0 (5.0, 8.0)
Depressed mood index	3.0 (3.0, 3.0)
Somatic symptoms index	2.0 (2.0, 3.0)
Optimism index	2.0 (2.0, 3.0)
Items not clustered into an index	10.0 (8.0, 12.0)
HAMD (median, IQR)	2.0 (0, 3.0)
Assessment of motor symptoms
JRS (median, IQR)	6.0 (5.0, 7.0)
JRS-severity	3.0 (2.0, 3.5)
JRS-frequency	3.0 (3.0, 3.0)
BSDI (median, IQR)	1.0 (0.7, 1.9)

BoNT-A: Botulinum toxin A; SAS: Self-rating Anxiety Scale; IQR: Interquartile range; HAMA: Hamilton Anxiety Scale; SDS: Self-rating Depression Scale; HAMD: Hamilton Depression Scale; JRS: Jankovic Rating Scale; BSDI: Blepharospasm Disability Index.

Table 2 Comparison of motor symptom, anxious and depression scales and their subscale scores in blepharospasm between baseline and treatment, median (interquartile range)

	Baseline (n = 21)	Treatment (n = 21)	P value
Anxious and subscale scores
SAS	30 (25.5, 35.5)	27 (25, 30)	0.211
Anxiety and panic	5 (5, 7.5)	5 (5, 6)	0.580
Anxiety	1 (1, 1)	1 (1, 1)	0.712
Fear	1 (1, 1)	1 (1, 1)	1.000
Panic	1 (1, 2)	1 (1, 1.5)	0.429
Feeling crazy	1 (1, 1)	1 (1, 1)	0.299
Flushed face	1 (1, 1)	1 (1, 1)	0.288
Somatic control	6 (5, 8)	5 (5, 7.5)	0.441
Premonition of misfortune	1 (1, 2)	1 (1, 1.5)	0.755
Inability to sit still	1 (1, 1.5)	1 (1, 1)	0.019a
Dyspnea	1 (1, 1)	1 (1, 1)	0.317
Hyperhidrosis	1 (1, 1.5)	1 (1, 1)	0.738
Sleep disorder	1 (1, 2)	1 (1, 2)	0.808
Vestibular sensations	5 (5, 5.5)	5 (5, 6)	0.601
Trembling hands and feet	1 (1, 1)	1 (1, 1)	0.554
Palpitation	1 (1, 1)	1 (1, 1)	0.973
Dizziness	1 (1, 1)	1 (1, 1.5)	0.244
Syncope	1 (1, 1)	1 (1, 1)	0.317
Tingling of hands and feet	1 (1, 1)	1 (1, 1)	0.592
Gastrointestinal/muscular sensations	6 (5, 8)	5 (5, 6)	0.134
Headache	1 (1, 2)	1 (1, 1)	0.039a
Fatigue	1 (1, 1.5)	1 (1, 2)	0.407
Stomach pain and indigestion	1 (1, 1)	1 (1, 1)	0.076
Frequent urination	1 (1, 1.5)	1 (1, 1)	0.075
Nightmare	1 (1, 1)	1 (1, 1)	0.408
HAMA	2 (0, 3.5)	0 (0, 1.5)	0.094
Depression and subscale scores
SDS	30 (25, 34)	26 (25, 28.5)	0.096
Well-being index	5 (5, 8)	5 (5, 5)	0.029a
Decreased capacity	1 (1, 1.5)	1 (1, 1)	0.019a
Hard to decide	1 (1, 1.5)	1 (1, 1)	0.019a
Feeling of uselessness	1 (1, 2)	1 (1, 1)	0.052
Empty-minded	1 (1, 1.5)	1 (1, 1)	0.094
Loss of interest	1 (1, 1)	1 (1, 1)	0.158
Depressed mood index	3 (3, 3)	3 (3, 3)	0.607
Dejection	1 (1, 1)	1 (1, 1)	0.639
Weepiness	1 (1, 1)	1 (1, 1)	0.317
Sense of worthlessness	1 (1, 1)	1 (1, 1)	0.317
Somatic symptoms index	2 (2, 3)	2 (2, 3)	0.924
Palpitation	1 (1, 1)	1 (1, 1)	0.152
Fatigue	1 (1, 1)	1 (1, 2)	0.435
Optimism index	2 (2, 3)	2 (2, 2)	0.091
Thought disorder	1 (1, 1.5)	1 (1, 1)	0.081
Despair	1 (1, 1.5)	1 (1, 1)	0.081
Items not clustered into an index	10 (8, 12)	9 (8, 10.5)	0.327
Heavy in the morning and light at night	1 (1, 2)	1 (1, 1)	0.334
Sleep disorder	1 (1, 3)	1 (1, 2.5)	0.820
Loss of appetite	1 (1, 1)	1 (1, 1)	1.000
Hyposexual interest	1 (1, 1)	1 (1, 1)	0.592
Weight loss	1 (1, 1)	1 (1, 1)	0.317
Constipation	1 (1, 1)	1 (1, 1)	0.576
Insecurity	1 (1, 1)	1 (1, 1)	0.311
Irritability	1 (1, 1.5)	1 (1, 1)	0.419
HAMD	2 (0, 3)	1 (0, 3)	0.395
Motor symptom and subscale scores
JRS	6 (5, 7)	6 (4, 6.5)	0.393
JRS-severity	3 (2, 3.5)	3 (2, 3)	0.685
JRS-frequency	3 (3, 3)	3 (2, 3)	0.190
BSDI	1 (0.71, 1.9)	0.83 (0.35, 1.415)	0.255

^aP < 0.05.

SAS: Self-rating Anxiety Scale; HAMA: Hamilton Anxiety Scale; SDS: Self-rating Depression Scale; HAMD: Hamilton Depression Scale; JRS: Jankovic Rating Scale; BSDI: Blepharospasm Disability Index.

Table 3 Stepwise multiple logistic regression about Self-rating Depression Scale and Self-rating Anxiety Scale total and their subscale scores with botulinum toxin A treatment

Index1	Category1	OR2	P value2	95%CI2
SDS total score	25-29	Reference
	30-31	0.588	0.559	0.099-3.491
	≥ 32	0.074	0.021a	0.008-0.678
SDS well-being index	5	Reference
	6	0.684	0.795	0.039-11.949
	> 6	0.098	0.039a	0.011-0.892

^aP < 0.05.

¹Dependent variables.

²Independent variable (botulinum toxin A).

SDS: Self-rating Depression Scale; OR: Odds ratio; CI: Confidence interval.