A double-blind, randomized, controlled study of botulinum toxin type A in MS-related tremor

Walt, Anneke van der; Sung, Simon; Spelman, Tim; Marriott, Mark; Kolbe, Scott; Mitchell, Peter; Evans, Andrew; Butzkueven, Helmut

doi:10.1212/wnl.0b013e31825dcdd9

Cited by 70 publications

(55 citation statements)

References 30 publications

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“…Small case series or single cases showed improvement after carbamazepine [116], propranolol, topiramate [117], primidone [118], isoniazid, ondansetron, or 4-aminopyridine [119], but there is insufficient evidence to support or refute efficacy of these drugs. A recent randomized, placebo-controlled, cross-over study [120] assessed botulinum toxin for MS-related limb tremor in 23 patients. Differences in all primary outcomes were highly significant at 6 and 12 weeks.…”

Section: Treatment Of Cerebellar Tremor Related To Msmentioning

confidence: 99%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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Tremor is a hyperkinetic movement disorder characterized by rhythmic oscillations of one or more body parts. It can be disabling and may impair quality of life. Various etiological subtypes of tremor are recognized, with essential tremor (ET) and Parkinsonian tremor being the most common. Here we review the current literature on tremor treatment regarding ET and head and voice tremor, as well as dystonic tremor, orthostatic tremor, tremor due to multiple sclerosis (MS) or lesions in the brainstem or thalamus, neuropathic tremor, and functional (psychogenic) tremor, and summarize main findings. Most studies are available for ET and only few studies specifically focused on other tremor forms. Controlled trials outside ET are rare and hence most of the recommendations are based on a low level of evidence. For ET, propranolol and primidone are considered drugs of first choice with a mean effect size of approximately 50 % tremor reduction. The efficacy of topiramate is also supported by a large double-blind placebocontrolled trial, while other drugs have less supporting evidence. With a mean effect size of about 90 % deep brain stimulation in the nucleus ventralis intermedius or the subthalamic nucleus may be the most potent treatment; however, there are no controlled trials and it is reserved for severely affected patients. Dystonic limb tremor may respond to anticholinergics. Botulinum toxin improves head and voice tremor. Gabapentin and clonazepam are often recommended for orthostatic tremor. MS tremor responds only poorly to drug treatment. For patients with severe MS tremor, thalamic deep brain stimulation has been recommended. Patients with functional tremor may benefit from antidepressants and are best be treated in a multidisciplinary setting. Several tremor syndromes can already be treated with success. But new drugs specifically designed for tremor treatment are needed. ET is most likely covering different entities and their delineation may also improve treatment. Modern study designs and long-term studies are needed.

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Section: Treatment Of Cerebellar Tremor Related To Msmentioning

confidence: 99%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…[3][4][5] We recently demonstrated that targeted onabotulinumtoxin A, a drug commonly used for focal dystonia, 6 reduces upper limb tremor severity in MS patients. 1,7 This finding, together with empiric clinical observation, raises the possibility that dystonia contributes to tremor in MS.The purpose of this study was to investigate the presence of upper limb dystonia and its contribution to tremor occurrence and severity in MS. We therefore recorded the presence and severity of dystonia in well-matched MS patients with and without tremor. …”

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confidence: 98%

The occurrence of dystonia in upper-limb multiple sclerosis tremor

Walt¹,

Buzzard

Sung

et al. 2015

Mult Scler

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“…However, studies of the effect of BT on other upper limb tremor types have had heterogeneous results in terms of functional disability. Although a placebo-controlled trial in multiple sclerosis-associated tremor1 and a case report in anti-MAG neuropathy-related tremor2 described significant improvement of both tremor and function, other studies of BT in essential or parkinsonian tremor failed to demonstrate functional improvement3,4 and/or to show change in objective tremor measures 5…”

Section: Discussionmentioning

confidence: 99%

“…In this context, use of botulinum toxin (BT) injections has had mixed results. Some studies have described significant improvement of both tremor and function,1,2 but others have failed to confirm those benefits 3–5…”

Section: Introductionmentioning

confidence: 99%