Botulinum Toxin for Treatment of Synkinesis: Effects on Anxiety and Depression

Facial synkinesis is associated with increased anxiety/depression and decreased quality of life.

To evaluate changes in anxiety and depression among patients with synkinesis before and after chemodenervation as measured by validated scales.

A retrospective review of botulinum toxin naïve adults treated with chemodenervation for synkinesis was performed. Validated outcome metrics were compared before the first treatment and >3 months after the final treatment. Clinician-graded assessment used the Sunnybrook Facial Grading System (SB). Patient-reported assessments included the Synkinesis Assessment Questionnaire (SAQ) and Facial Clinimetric Evaluation (FaCE). Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) questionnaires assessed depression and anxiety. Paired t-tests compared scores before and after treatment.

Sixty-eight patients aged 54 years (standard deviation ±13.5) were included. Most patients were female, 53/68 (78%). Bell's palsy was the most common cause, 34/68 (50%), with a median duration of 42 months (ranging from 4 to 730). Twelve participants (17.6%) initially screened positive for depression, and 11 (16.2%) for anxiety. Chemodenervation demonstrated significant improvements in SB (t = -7.14, p < 0.0001), FaCE (t = -2.15, p = 0.041), GAD-2 (t = 2.18, p = 0.03), and PHQ-2 scores (p = 0.016). There was no significant change in SAQ (standardized mean difference = -0.9, p = 0.71).

Chemodenervation for synkinesis demonstrated improved patient quality of life and reduced symptoms of anxiety and depression.