Chemodenervation Is Associated With Decreased Mental Health Disorders in Patients With Synkinesis

Introduction: Facial synkinesis, involuntary facial movements coinciding with deliberate actions of a specific facial muscle group, is a distressing consequence of facial paralysis. This study uses a large database to compare mental health disorder prevalence in individuals with facial synkinesis, facial paralysis alone, and controls.

Methods: The TriNetX Network was queried from 2011 to 2021 for patients with facial paralysis without synkinesis, facial paralysis and documented synkinesis, and controls, matched for age, sex, race, and ethnicity. Cases included infectious, iatrogenic, or idiopathic facial paralysis. Patients with pre-existing depression or anxiety were excluded. Two-year rates of newly diagnosed depression, anxiety, and mental health prescriptions were compared.

Results: Among 131,154 patients with facial paralysis, 92.6% (n=121,464) had documented facial paralysis alone, and 7.4% (n=9,690) also had documented synkinesis. Compared to controls, patients with facial paralysis alone had increased risks of new depression (8.9% vs. 7.3%, RR 1.22, P< 0.001) and anxiety (10.1% vs. 9.6%, RR 1.05, P< 0.001), with higher mental health medication rates (16.6% vs. 13.1%, RR 1.26, P< 0.001). Synkinesis patients, in comparison to controls, had the highest risks of depression (19.8% vs. 8.6%, RR 2.30, P< 0.001), anxiety (20.5% vs. 10.5%, RR 1.96, P< 0.001), and prescriptions (28.1% vs. 15.8%, RR 1.79, P< 0.001). The 27.9% (n=2,704) of synkinetic patients treated with chemodenervation had lower rates of depression (8.5% vs. 23.5%, RR 0.36, P< 0.001), anxiety (9.0% vs. 23.8%, RR 0.38, P< 0.001), and prescriptions (21.6% vs. 30.0%, RR 0.72, P< 0.001) compared to synkinetic patients who were not. Only 0.2% (n=22) of synkinetic patients underwent documented neurectomy/myectomy.

Conclusions: Facial paralysis, especially synkinesis, is associated with heightened mental health disorders. Integrating mental health screening and treatment into a comprehensive approach is crucial. Chemodenervation is associated with reduced mental health disorders in synkinesis, emphasizing its therapeutic potential.