The impact of blepharospasm and cervical dystonia on health-related quality of life and depression

Abstract

The aim of the study was to evaluate and compare health-related quality of life (HR-QoL) and depression in essential blepharospasm (BSP) and idiopathic cervical dystonia (CD), to identify the clinical and demographic factors associated with poor HR-QoL in both disorders and to analyse the effect of Botulinum Toxin A (BtxA) therapy. Two hundred-twenty consecutive patients with BSP (N = 89, 62 % women, mean age 64 years, mean disease duration 7 years) and CD (N = 131, 64 % women, mean age 53 years, mean disease duration 8 years) recruited from routine referrals to eight Austrian dystonia clinics were included. HR-QoL was measured by the Short Form 36 (SF-36) and depression by the Beck Depression Inventory (BDI). At baseline, patients with CD and BSP scored significantly worse in all eight SF-36 domains compared with an age-matched community sample. In addition, 47 % of patients with CD and 37 % of those with BSP were depressed. Women with BSP scored significantly lower in all SF-36 domains and were more depressed than male patients. In contrast, there was no significant effect of gender on HR-QoL and depression in CD. Neck pain had a significant impact on all SF-36 domains and represented the main determinant of depression in CD. Although BtxA therapy resulted in a significant improvement of clinical symptoms in BSP and CD, HR-QoL did not improve in BSP and only two of the eight SF-36 domains improved significantly in patients with CD. The present study for the first time demonstrated that BSP has a substantial impact on health status emphasizing the need for psychological support with interventions aimed at treating depression in these patients. Our results provide further evidence for the profound impact of CD on HR-QoL and indicate the importance of an adequate management of neck pain in addition to reducing the severity of dystonia in CD. The mismatch between objective BtxA derived improvement of dystonia and lack of change of HR-QoL as determined by the SF-36 illustrates the need for optimized disease specific quality of life rating scales in patients with craniocervical dystonia.

Nonmotor symptoms in primary adult‐onset cervical dystonia and blepharospasm

“…Muller et al. (2002) found depression of some BSP and CD patients did not improve correspondingly after significant relief of motor symptom and pain by botulinum toxin A treatment, which supported our findings that no significant correlation was found between depression and motor severity. The observation that more than half of CD patients developed depression before the onset of motor symptom (Wenzel et al., 1998), challenged the traditional view that mood disorders were secondary to motor disability in dystonia.…”

The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia

“…Even as a generic measure of health status widely adopted to assess QoL 8 , the SF-36 has not been used in this study, since it has undergone a considerable amount of reliability tests and validity studies, proving to be impaired in patients with craniocervical dystonia 9 . The 24 questions of the CDQ-24 are divided in five areas: stigma (6), emotional wellbeing (5), pain (3), activities of daily living (6) and family/social life (4). Each question has five possible answers, in which 0 (zero) is the best and 4 is the worst.…”

“…Although different studies 4,5,6 have evaluated the impact on the QoL of patients with cervical dystonia, few use a specific scale for the disease.…”

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

“…2,3 With time, the phenomenon becomes more frequent until it causes difficulty with carrying out daily activities, and impairs health-related quality of life, causing social embarrassment, anxiety, and depression. [3][4][5] Rarely the spasm can cause functional blindness. 5 A variety of treatments are available for facial dystonias: treatment of dry eye symptoms, referral to patient groups, 3 treatment with drugs including antidepressants, anxiolytics, anticonvulsants, anti-Parkinson drugs, and muscle relaxants, 6 and surgery including facial nerve avulsion, 7 orbicularis oculi myectomy, [8][9][10] and brow suspension.…”