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L.B. Kline, T.A. Hall, G. McGwin, Jr, K. Searcey, A. Xie, S.L. Hupp, C. Owsley; Primary Blepharospasm: Risk Factors With Reference to Hemifacial Spasm . Invest. Ophthalmol. Vis. Sci. 2005;46(13):619.
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Purpose: To identify risk factors associated with primary blepharospasm (BSP) with reference to hemifacial spasm (HFS). Persons with BSP and HFS experience similar physical symptoms yet it is clearly established that the two disorders have different etiologies. Thus HFS patients are a useful comparison group in epidemiological case–control studies to identify risk factors for BSP. Methods: Patients with either BSP (cases, N=159) or HFS (controls, N=91) were identified from two large neuro–ophthalmology clinics in Alabama. Demographic, medical, behavioral, and psychological characteristics were obtained from chart abstraction and a patient telephone survey. Results: The average age of both cases and controls was 66 years. The majority of patients in both groups were retired, white, and female. There was no difference between the two groups regarding demographics, smoking, family history of dystonia, Parkinson’s disease, obsessive compulsive symptoms, history of head trauma, alcohol use, or caffeine consumption. BSP patients were 1.5 times more likely to meet the diagnostic criteria for generalized anxiety disorder (p=0.0072) than HFS patients. Conclusions: In the largest case–control study on BSP to date, we report that BSP is associated with generalized anxiety disorder. Contrary to previous studies where the number of BSP cases studied was small, in the present study BSP was not associated with obsessive–compulsive disorder, head trauma, or a family history of BSP, other forms of dystonia, or Parkinson's disease, nor was there a protective association for smoking. Given the striking similarity in the physical symptoms experienced by BSP and HFS patients, if an anxiety disorder was a sequelae, a similar percentage in both groups would be expected to have this psychiatric disorder. However, this was not the case, implying that consideration should be given to the possibility that generalized anxiety disorder may have a role in BSP etiology.
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