The Association of Mental Health Disorders with the Effectiveness of Treating Facial Synkinesis with Chemodenervation Using Botulinum Toxin A.

Studies suggest that mood disorders may affect perception of facial synkinesis, though none have analyzed effects on perceived benefit from chemodenervation. To measure the effect of depression, appearance anxiety, and other variables on chemodenervation benefit among patients with post-paralytic facial synkinesis. Prospective cohort. Patients volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), Facial Clinimetric Evaluation Scale (FaCE), Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Multivariate regression was used to analyze the effect of CES-D, FNAES, and demographics on pre- and post-chemodenervation SAQ and FaCE. In total, 100 patients participated, 90% were female. Mean age was 56.4 (SD 12.3) years. The most common paralysis etiology was idiopathic (47%). Average synkinesis duration was 7.6 (6.2) years and treatment duration 4.9 (4.8) years. Older age and prior treatment ( < 0.05) were associated with reduced SAQ improvement; worse CES-D approached significance ( = 0.09). Reported history of anxiety was associated with greater SAQ improvement ( = 0.05). Factors associated with reduced FaCE improvement included higher baseline CES-D and prior treatment ( < 0.05). Older age, worse depression scores, and prior treatments may be associated with reduced patient-graded improvement following chemodenervation. History of anxiety may be associated with greater improvement.