Botulinum toxin in essential hand tremor - A randomized double-blind placebo-controlled study with customized injection approach

Mittal, Shivam Om; Machado, Duarte; Richardson, D. E.; Dubey, Divyanshu; Jabbari, Bahman

doi:10.1016/j.parkreldis.2018.06.019

Cited by 48 publications

(79 citation statements)

References 12 publications

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“…These studies were not included because they did not meet inclusion criteria or have been reported since we concluded the review process. Examples are the assessment of interventions administered on an as‐needed regimen, including the more recently studied octanol and its derivatives, open label assessment of perampanel, customized approach for botulinum toxin administration to improve safety in the treatment of hand tremor, other DBS approaches with assessment of targets such as the Zona Incerta/Posterior Subthalamic area, the STN, use of constant‐current or closed loop stimulation paradigms, and novel MRI‐guided approaches for thalamotomy . These interventions will likely merit assessment in a future MDS‐EBM review on ET.…”

Section: Discussionmentioning

confidence: 99%

MDS evidence‐based review of treatments for essential tremor

et al. 2019

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Background Essential tremor is one of the most prevalent movement disorders. Many treatments for essential tremor have been reported in clinical practice, but it is uncertain which options have the most robust evidence. The International Parkinson and Movement Disorder Society commissioned a task force on tremor to review clinical studies of treatments for essential tremor. Objectives To conduct an evidence‐based review of current pharmacological and surgical treatments for essential tremor, using standardized criteria defined a priori by the International Parkinson and Movement Disorder Society. Methods We followed the recommendations of the International Parkinson and Movement Disorder Society Evidence Based Medicine Committee. Results Sixty‐four studies of pharmacological and surgical interventions were included in the review. Propranolol and primidone were classified as clinically useful, similar to Topiramate, but only for doses higher than 200 mg/day. Alprazolam and botulinum toxin type A were classified as possibly useful. Unilateral Ventralis intermedius thalamic DBS, radiofrequency thalamotomy, and MRI‐guided focused ultrasound thalamotomy were considered possibly useful. All the above recommendations were made for limb tremor in essential tremor. There was insufficient evidence for voice and head tremor as well as for the remaining interventions. Conclusion Propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions in which the data reviewed robustly supported efficacy. Their safety profile and patient preference may guide the prioritization of these interventions in clinical practice. MRI‐guided focused ultrasound thalamotomy was, for the first time, assessed and was considered to be possibly useful. There is a need to improve study design in essential tremor and overcome the limitation of small sample sizes, cross‐over studies, short‐term follow‐up studies, and use of nonvalidated clinical scales. © 2019 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

MDS evidence‐based review of treatments for essential tremor

et al. 2019

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“…Jankovic suggested using a customized rather than fixed pattern of injection for tremor [7,8]. Publications over the past 3 years, however, have provided further support for the efficacy of BoNT therapy in treatment of ET and Parkinson disease tremor; these studies have described newer techniques, the employment of which has substantially reduced the incidence of hand and finger weakness in ET and PD-related tremor following BoNT therapy [9][10][11].…”

Section: S2mentioning

confidence: 99%

“…At Yale University, we investigated the efficacy of BoNT-A injection in 28 patients with ET using a customized approach [9]. The study was randomized, placebo-controlled and double blind with a cross over design (cross over with placebo or vice versa occurred 4 months after the first injection).…”

Section: S3mentioning

confidence: 99%

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Progress in Management of Essential and Parkinson Disease Tremor with Botulinum Toxin Injections-Established Efficacy and Less Adverse Effects

Jabbari¹

2019

J Neurol Exp Neurosci

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Tremor is a common movement disorder, and in severe cases, often disables the patients. Essential tremor (ET) and Parkinson-related tremor are two of the most common forms encountered. Earlier double blind and placebo-controlled studies had suggested efficacy of BoNT-A injections into the forearm muscles in reducing the hand and forearm tremor in patients with essential tremor (ET). High quality publications over the past two years have established the efficacy of botulinum toxin-A therapy for ET as well as demonstrating probable efficacy of BoNT-A injections in Parkinson disease tremor. These recent publications also describe novel techniques such as the one used in the Yale protocol using EMG screening and a customized approach and the kinematic computerized amplitude analysis of tremor that have substantially reduced the incidence of hand and forearm weakness reported as adverse effects in the previous high quality studies.

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“…A tailored individual injection schedule has been shown to be effective in treating multiple sclerosis–related tremor (proximal and distal upper limbs), hand tremor a result of Parkinson's disease, hand tremor of various etiology (mainly essential and dystonic tremor), and proximal upper limb tremor of various etiology . The authors of this article have been treating upper limb tremor with botulinum toxin for a combined total of more than 35 years and have found a sustained functional improvement using this approach in an observational study (poster presentation) .…”

mentioning

confidence: 98%