Motor and psychiatric features in idiopathic blepharospasm: A data-driven cluster analysis


      • Psychiatric symptoms are part of the clinical spectrum of Idiopathic blepharospasm.
      • Depression and anxiety scores were higher in patients than in controls.
      • Cluster analysis with motor/psychiatric resulted in three groups of patients.
      • Lowest severity of psychiatric symptoms in the least severe motor symptoms' cluster.
      • Highest psychiatric severity scores in the intermediate motor severity cluster.



      Idiopathic blepharospasm is a clinically heterogeneous dystonia also characterized by non motor symptoms.


      We used a k-means cluster analysis to assess 188 patients with idiopathic blepharospasm in order to identify relatively homogeneous subpopulations of patients, using a set of motor and psychiatric variables to generate the cluster solution.


      Blepharospasm patients reached higher scores on scales assessing depressive- and anxiety-related disorders than healthy/disease controls. Cluster analysis suggested the existence of three groups of patients that differed by type of spasms, overall motor severity, and presence/severity of psychiatric problems. The greater severity of motor symptoms was observed in Group 1, the least severity in Group 3, while the severity of blepharospasm in Group 2 was between that observed in Groups 1 and 3. The three motor subtypes also differed by psychiatric features: the lowest severity of psychiatric symptoms was observed in the group with least severe motor symptoms (group 3), while the highest psychiatric severity scores were observed in group 2 that carried intermediate motor severity rather than in the group with more severe motor symptoms (group 1). The three groups did not differ by disease duration, age of onset, sex or other clinical features.


      The present study suggests that blepharospasm patients may be classified in different subtypes according to the type of spasms, overall motor severity and presence/severity of depressive symptoms and anxiety.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Parkinsonism & Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Defazio G.
        • Hallett M.
        • Jinnah H.A.
        • Conte A.
        • Berardelli A.
        Blepharospasm 40 years later.
        Mov. Disord. 2017 Apr; 32: 498-509
        • Berman B.D.
        • Junker J.
        • Shelton E.
        • et al.
        Psychiatric associations of adult-onset focal dystonia phenotypes.
        J. Neurol. Neurosurg. Psychiatry. 2017 Jul; 88: 595-602
        • Defazio G.
        • Conte A.
        • Gigante A.F.
        • et al.
        Clinical heterogeneity in patients with idiopathic blepharospasm: a cluster analysis.
        Park. Relat. Disord. 2017 Jul; 40: 64-68
        • Defazio G.
        • Jinnah H.A.
        • Berardelli A.
        • et al.
        Diagnostic criteria for blepharospasm: a multicenter international study.
        Park. Relat. Disord. 2021 Oct; 91: 109-114
        • Albanese A.
        • Bhatia K.
        • Bressman S.B.
        • et al.
        Phenomenology and classification of dystonia: a consensus update.
        Mov. Disord. 2013 Jun 15; 28: 863-873
        • Defazio G.
        • Hallett M.
        • Jinnah H.A.
        • Stebbins G.T.
        • Gigante A.F.
        • Ferrazzano G.
        • Conte A.
        • Fabbrini G.
        • Berardelli A.
        Development and validation of a clinical scale for rating the severity of blepharospasm.
        Mov. Disord. 2015 Apr; 30: 525-530
        • Foa E.B.
        • Huppert J.D.
        • Leiberg S.
        • et al.
        The Obsessive-Compulsive Inventory: development and validation of a short version.
        Psychol. Assess. 2002 Dec; 14: 485-496
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr. Scand. 1983 Jun; 67: 361-370
        • Liebowitz M.R.
        Social phobia.
        Mod. Probl. Pharmacopsychiatr. 1987; 22: 141-173
        • Ferrazzano G.
        • Conte A.
        • Gigante A.
        • et al.
        Disease progression in blepharospasm: a 5-year longitudinal study.
        Eur. J. Neurol. 2019 Feb; 26: 268-273
        • Formann A.K.
        DieLatent-Class-Analyse: Einführung in die Theorie und Anwendung.
        Beltz, Weinheim1984
        • Wang X.
        • Zhang Z.
        • Mao Z.
        • Yu X.
        Deep brain stimulation for Meige syndrome: a meta-analysis with individual patient data.
        J. Neurol. 2019 Nov; 266: 2646-2656