{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:09:17Z","timestamp":1760058557356,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 &lt; 0.001). No significant correlation was found between the clinical and demographic features (p &gt; 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.<\/jats:p>","DOI":"10.3390\/jcm14082574","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T05:03:07Z","timestamp":1744174987000},"page":"2574","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Rehabilitation as a Possible Therapeutic Approach in Patients with Blepharospasm"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8481-2155","authenticated-orcid":false,"given":"Francesco","family":"Marchet","sequence":"first","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"},{"name":"IRCCS Neuromed, via Atinense 18, 86077 Pozzilli, IS, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Belvisi","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"},{"name":"IRCCS Neuromed, via Atinense 18, 86077 Pozzilli, IS, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6631-6740","authenticated-orcid":false,"given":"Giorgio","family":"Leodori","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"},{"name":"IRCCS Neuromed, via Atinense 18, 86077 Pozzilli, IS, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Aiello","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4369-014X","authenticated-orcid":false,"given":"Matteo","family":"Costanzo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Istituto Superiore di Sanit\u00e0, Viale Regina Elena 299, 00161 Rome, RM, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5891-7625","authenticated-orcid":false,"given":"Federica","family":"Satriano","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Di Vita","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6338-2961","authenticated-orcid":false,"given":"Antonella","family":"Conte","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"},{"name":"IRCCS Neuromed, via Atinense 18, 86077 Pozzilli, IS, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Fabbrini","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"},{"name":"IRCCS Neuromed, via Atinense 18, 86077 Pozzilli, IS, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina","family":"Ferrazzano","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 30, 00185 Rome, RM, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1212\/WNL.0b013e31829bfdf6","article-title":"Development and Validation of a Clinical Guideline for Diagnosing Blepharospasm","volume":"81","author":"Defazio","year":"2013","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/mds.25475","article-title":"Phenomenology and Classification of Dystonia: A Consensus Update","volume":"28","author":"Albanese","year":"2013","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1002\/mds.26156","article-title":"Development and Validation of a Clinical Scale for Rating the Severity of Blepharospasm","volume":"30","author":"Defazio","year":"2015","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1002\/mds.20889","article-title":"Analysis of Blink Rate in Patients with Blepharospasm","volume":"21","author":"Bentivoglio","year":"2006","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/mdc3.12499","article-title":"INCREASED BLINKING MAY BE A PRECURSOR OF BLEPHAROSPASM: A LONGITUDINAL STUDY","volume":"4","author":"Conte","year":"2017","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/brain\/108.3.593","article-title":"Pathophysiology of Blepharospasm and Oromandibular Dystonia","volume":"108","author":"Berardelli","year":"1985","journal-title":"Brain J. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1002\/mds.25567","article-title":"The Focal Dystonias: Current Views and Challenges for Future Research","volume":"28","author":"Jinnah","year":"2013","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/mds.870030108","article-title":"Blink Reflex Studies in Focal Dystonias: Enhanced Excitability of Brainstem Interneurons in Cranial Dystonia and Spasmodic Torticollis","volume":"3","author":"Tolosa","year":"1988","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s00415-019-09243-x","article-title":"Writing, Reading, and Speaking in Blepharospasm","volume":"266","author":"Ferrazzano","year":"2019","journal-title":"J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/01676830.2022.2151628","article-title":"Quantitative assessment of botulinum toxin injection on blink rate in blepharospasm","volume":"42","author":"Yazdanpanah","year":"2023","journal-title":"Orbit"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2374","DOI":"10.1002\/brb3.2374","article-title":"Blink index as a response predictor of blepharospasm to botulinum neurotoxin-A treatment","volume":"11","author":"Jang","year":"2021","journal-title":"Brain Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.ophtha.2008.12.031","article-title":"FL-41 tint improves blink frequency, light sensitivity, and functional limitations in patients with benign essential blepharospasm","volume":"116","author":"Blackburn","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice Guideline Update Summary: Botulinum Neurotoxin for the Treatment of Blepharospasm, Cervical Dystonia, Adult Spasticity, and Headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"86","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1159\/000116805","article-title":"Botulinum Toxin as a Treatment for Blepharospasm, Spasmodic Torticollis and Hemifacial Spasm","volume":"32","author":"Albanese","year":"1992","journal-title":"Eur. Neurol."},{"key":"ref_15","first-page":"443","article-title":"Blinking","volume":"237","author":"Karson","year":"1989","journal-title":"Bull. Soc. Belge Ophtalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10569","DOI":"10.1523\/JNEUROSCI.0079-06.2006","article-title":"Cerebellar Modulation of Trigeminal Reflex Blinks: Interpositus Neurons","volume":"26","author":"Chen","year":"2006","journal-title":"J. Neurosci. Off. J. Soc. Neurosci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.neulet.2005.01.077","article-title":"Neural Correlates of Eye Blinking; Improved by Simultaneous fMRI and EOG Measurement","volume":"381","author":"Yoon","year":"2005","journal-title":"Neurosci. Lett."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11256","DOI":"10.1523\/JNEUROSCI.6218-10.2011","article-title":"Characterizing the Spontaneous Blink Generator: An Animal Model","volume":"31","author":"Kaminer","year":"2011","journal-title":"J. Neurosci. Off. J. Soc. Neurosci."},{"key":"ref_19","first-page":"11","article-title":"A Functional Magnetic Resonance Imaging Study in Patients with Benign Essential Blepharospasm","volume":"23","author":"Baker","year":"2003","journal-title":"J. Neuro-Ophthalmol. Off. J. N. Am. Neuro-Ophthalmol. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.parkreldis.2020.06.034","article-title":"Basal Ganglia and Cerebellar Circuits Have Distinct Roles in Blepharospasm","volume":"78","author":"Glickman","year":"2020","journal-title":"Park. Relat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Peterson, D.A., and Sejnowski, T.J. (2017). A Dynamic Circuit Hypothesis for the Pathogenesis of Blepharospasm. Front. Comput. Neurosci., 11.","DOI":"10.3389\/fncom.2017.00011"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2574\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:13:06Z","timestamp":1760029986000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14082574"],"URL":"https:\/\/doi.org\/10.3390\/jcm14082574","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,4,9]]}}}