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

<b>Background:</b> Studies suggest that mood disorders may affect perception of facial synkinesis, though none have analyzed effects on perceived benefit from chemodenervation. <b>Objective:</b> To measure the effect of depression, appearance anxiety, and other variables on chemodenervation benefit among patients with post-paralytic facial synkinesis. <b>Design Type:</b> Prospective cohort. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> < 0.05) were associated with reduced SAQ improvement; worse CES-D approached significance (<i>p</i> = 0.09). Reported history of anxiety was associated with greater SAQ improvement (<i>p</i> = 0.05). Factors associated with reduced FaCE improvement included higher baseline CES-D and prior treatment (<i>p</i> < 0.05). <b>Conclusions:</b> 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.