Psychiatric disorders in blepharospasm. A 10-year follow-up study

Blepharospasm (BSP) is a cranial dystonia characterized by involuntary bilateral orbicularis oculi (OO) muscle spasms. BSP patients also display psychiatric disorders though the relationship between motor symptoms and psychiatric disorders in BSP is still a matter of debate (Conte et al., 2016). Previous observations have either suggested that psychiatric disorders in BSP are independent of motor symptoms or that they are consequences of motor symptoms (Fabbrini et al., 2010; Ferrazzano et al., 2019a). To investigate whether psychiatric disorders in BSP are part of the disease or merely consequences of the motor symptomatology, we performed a longitudinal assessment of psychiatric and motor symptoms to see whether psychiatric disorders changed over time independently of motor symptoms. We enrolled 14 patients with idiopathic BSP diagnosed according to clinical criteria. To exclude any confounding effects due to botulinum toxin (BoNT) injections, the clinical assessment was performed four months after the last BoNT injection. The experimental procedure was approved by the local institutional review board and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from each participant. A full psychiatric evaluation using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) was performed. The Hamilton Anxiety Rating Scale (HAM-A) was used to measure the severity of anxiety symptoms, while the Beck Depression Inventory (BDI) was used to measure depressive sy