Botulinum toxin for the treatment of hand tremor

Niemann, Nicki; Jankovic, Joseph

doi:10.1016/j.toxicon.2018.11.207

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…BoNT has been investigated as a treatment option for essential hand tremor since the early 1990s 55–60. Several open-label trials have shown that BoNT decreases the tremor amplitude; the improvement is predominantly of the postural component of the tremor 57 59–61. However, there are certain limitations to treatment of limb tremor with BoNT.…”

Section: Bont Therapy For Limb Tremormentioning

confidence: 99%

Treatment of essential tremor: current status

Sharma

Pandey

2019

Postgraduate Medical Journal

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Essential tremor is the most common cause of tremor involving upper limbs, head and voice. The first line of treatment for limb tremor is pharmacotherapy with propranolol or primidone. However, these two drugs reduce the tremor severity by only half. In medication refractory and functionally disabling tremor, alternative forms of therapy need to be considered. Botulinum toxin injections are likely efficacious for limb, voice and head tremor but are associated with side effects. Surgical interventions include deep brain stimulation; magnetic resonance-guided focused ultrasound and thalamotomy for unilateral and deep brain stimulation for bilateral procedures. Recent consensus classification for essential tremor has included a new subgroup, ‘Essential tremor plus’, who have associated subtle neurological ‘soft signs’, such as dystonic posturing of limbs and may require a different treatment approach. In this review, we have addressed the current management of essential tremor with regard to different anatomical locations of tremor as well as different modalities of treatment.

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Section: Bont Therapy For Limb Tremormentioning

confidence: 99%

Treatment of essential tremor: current status

Sharma

Pandey

2019

Postgraduate Medical Journal

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“…However, these techniques do not aid to objectively determine BoNT treatment patterns. 11 Techniques such as muscle palpation, EMG measurement of muscle tremor, or multi-joint kinematic tremor analysis are required to identify tremulous muscles for determining injection patterns. 10 , 12 Currently there are no standardized assessment methods for the selection of muscle groups to be targeted by BoNT-A for determining tremor treatment pattern without producing excessive arm weakness.…”

Section: Introductionmentioning

confidence: 99%

Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis

Samotus

Lee

Jog

2020

Ther Adv Neurol Disord

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Background: Inadequate efficacy and significant side effect profile makes pharmacological treatment of Parkinson’s disease (PD) tremor challenging. Personalized dosing of botulinum toxin type A (BoNT-A) using tremor analysis has shown efficacy and safety for treating upper limb tremor. This study incorporated a novel, standardized treatment algorithm for determining injection pattern and BoNT-A dosing, customizable by the physician, in PD patients with disabling tremor in one or both arms. Methods: This open-label study included 47 PD participants (25 “De-novo” and 22 “L-dopa”) who received 4 serial BoNT-A treatments with follow-ups at 6 weeks post-treatment over 42 weeks. The treatment algorithm utilized kinematic tremor analysis of each participant’s whole arm tremor and determined the physician’s injection pattern of BoNT-A. Endpoints included changes in angular tremor amplitude, Fahn-Tolosa-Marin (FTM C) tremor scale, Movement Disorder Society-Unified Parkinson’s disease rating scale (MDS-UPDRS) tremor-related score, tremor-related quality of life questionnaire, Likert ratings of perceived weakness, and maximal grip strength. Results: BoNT-A significantly ( p < 0.05) improved tremor amplitude (41.6%), quality of life (23.0%), UPDRS tremor score (29.6%), and arm function (FTM C; 24.6%) for both treatment cohorts from weeks 6 to 42. Maximum grip strength was reduced between 7.4% and 23.0% at follow-up visits and did not impact activities of daily living. Efficacy was obtained with first injection and remained without adjustment over two serial injection in 45% of participants. Conclusions: This is the first study to use a fully standardized treatment algorithm for personalization of BoNT-A injection patterns for disabling PD tremor over serial treatments. A sustained alleviation of tremor severity and improved arm function and quality of life fulfills an important unmet need for the treatment of PD tremor. This study demonstrated that BoNT-A can be administered as a monotherapy in tremor-dominant PD or as an add-on therapy for refractory PD tremor.

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“…There are a few case studies and open-label studies on BoNT in dystonic tremor. One of the largest case studies is from Baylor University in 31 patients with dystonic head tremor [23]. The mean dose of BoNT (OnabotulinumtoxinA) was 77.3 units with a range of (27.5-187.5) units.…”

Section: Botulinum Toxin In Dystonic Hand Tremormentioning

confidence: 99%