# Cognitive Rehabilitation as a Possible Therapeutic Approach in Patients with Blepharospasm

## TL;DR

This study explores how cognitive training, like reading and writing, can help reduce blinking and spasms in blepharospasm patients when used with botulinum toxin.

## Contribution

The study introduces cognitive training as a novel complementary therapy to botulinum toxin for blepharospasm.

## Key findings

- Cognitive training significantly improved blink rate reduction compared to botulinum toxin alone.
- Reading and writing tasks were most effective in reducing dystonic spasms.
- No correlation was found between clinical outcomes and demographic features.

## Abstract

Background/Objectives: Blepharospasm (BSP) is a focal dystonia characterized by involuntary, bilateral spasms of the orbicularis oculi muscle. While botulinum toxin (BoNT) is the standard treatment, cognitive tasks such as reading and writing may exert transient modulatory effects on spontaneous blinking and dystonic spasms. This study investigates the potential of cognitive training, including reading and writing tasks, as a complementary therapeutic approach to BoNT in BSP patients. Methods: A total of 16 BSP patients were randomly assigned to two groups: Group A (n = 6) received cognitive training alongside BoNT, while Group B (n = 10) received only BoNT. Cognitive training included structured reading and writing exercises over three months. Blink rate (BR) and dystonic spasms were assessed at baseline (T0), one month (T1), and three months (T2) post-treatment. Results: Both groups exhibited a significant reduction in BR at T1 (p = 0.001), but Group A exhibited a greater improvement in BR (45.4%) compared to that of Group B (12.6%, p = 0.04). Reading and writing tasks were the most effective in reducing BR and dystonic spasms (p < 0.001). No significant correlation was found between the clinical and demographic features (p > 0.05). Conclusions: Cognitive training significantly enhances the therapeutic effects of BoNT on BR in BSP patients, suggesting its potential as a non-invasive complementary intervention. These preliminary findings warrant further investigation using larger cohorts and employing neurophysiological assessments.