Objective: Evaluate the quality of life and the presence of anxiety and depression in HFS patients and their behavior after botulinum toxin administration.

Background: Hemifacial spasm (HFS) is a common condition associated with motor symptoms that impact mood, especially generating anxiety and depression in 15-30% of cases and thus affecting social and professional life. Botulinum toxin is the first-line treatment due to its high efficacy, improving 70-100% of motor symptoms and relieving non-motor symptoms. Some articles also suggest improvement in emotional symptoms supported by the facial feedback hypothesis.

Method: Prospective cohort study of patients diagnosed with HFS followed up in our Neurology Department with an indication for treatment with botulinum toxin. We evaluated patients before and 45 days after botulinum toxin application using Beck Depression Inventory (BDI-2) and Beck Anxiety Inventory (BAI) for mood and the SF-36 v.2 questionnaire for quality-of-life assessments. We also used the Marti, Tolosa and Alom (MTA) scale, the Functional Disability scale, the Social Anxiety and Distress Scale (SADS), patients’ subjective improvement in motor and emotional symptoms.

Results: 38 patients were evaluated, with a mean age of 56.4 years (SD: 12.07) and 73.7% (N: 28) were women. Mean HFS severity was 3.34 (SD: 0.62) and mean frequency was 4.6 (SD: 0.58) according to the MTA scale. Before treatment, 50% exhibited depression according to the BDI-2 scale, and 58% had anxiety according to the BAI scale. After treatment, all patients showed a decrease in the MTA scale and reported a subjective motor improvement of 7.18 (SD: 2.28). 71.1% reported subjective improvement in mood. Repeated measures ANOVA revealed a significant reduction in the BAI scale (p: 0.004) and comparisons using chi2 tests showed a significant improvement in the presence of depression (p: 0.019) and anxiety (p: 0.001) post-treatment. No statistically significant relationship was found with the other variables studied.

Conclusion: Our results suggest a high prevalence of depression and anxiety in HFS patients and an improvement in these symptoms after botulinum toxin injection. This highlights the underdiagnosis of these conditions and the need for targeted screening. However, further studies are required to understand the pathophysiological mechanisms and the relationship between the motor and emotional components of the pathology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-therapy-in-patients-with-hemifacial-spasm-beyond-the-treatment-of-motor-symptoms/