A Pilot Study of Botulinum Toxin for Jerky, Position-Specific, Upper Limb Action Tremor

Saifee, Tabish A.; Teodoro, Tiago; Erro, Roberto; Edwards, Mark J.; Cordivari, Carla

doi:10.7916/d8t153tq

Cited by 2 publications

(1 citation statement)

References 14 publications

(21 reference statements)

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“…Case series and isolated reports have documented improvement in primary writing tremor, ranging from 66% to 100% with BoNT. In a pilot study of 8 patients with jerky, position-specific upper limb action tremor, BoNT injections reduced the tremor severity. For patients with ET, pivotal randomized clinical studies using a fixed-dose approach found improvement in tremor, although the functional benefits were limited because of significant upper-extremity muscle weakness in the injected limbs.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor

et al. 2021

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IMPORTANCEThere is an unmet need for safe and efficacious treatments for upper-extremity dystonic tremor (DT). To date, only uncontrolled retrospective case series have reported the effect of botulinum neurotoxin (BoNT) injections on upper-extremity DT.OBJECTIVE To assess the effect of BoNT injections on tremor in patients with upper-extremity DT. DESIGN, SETTING, AND PARTICIPANTSIn this placebo-controlled, parallel-group randomized clinical trial, 30 adult patients with upper-extremity DT treated at a movement disorder clinic in a tertiary care university hospital were randomized in a 1:1 ratio to BoNT or saline injection, 0.9%, using a computer-generated randomization sequence. Randomization was masked using opaque envelopes. The participant, injector, outcome assessor, and statistician were blinded to the randomization. Participants were recruited between November 20, 2018, and December 12, 2019, and the last follow-up was completed in March 2020.INTERVENTIONS Participants received electromyographically guided intramuscular injections of BoNT or placebo into the tremulous muscles of the upper extremity. Injection patterns and doses were individualized according to tremor phenomenologic findings. MAIN OUTCOMES AND MEASURESThe primary outcome was the total score on the Fahn-Tolosa-Marin Tremor Rating Scale 6 weeks after the intervention. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. All patients were offered open-label BoNT injections after 12 weeks and reassessed 6 weeks later.RESULTS A total of 48 adult patients with a diagnosis of brachial dystonia with DT were screened. Fifteen were ineligible and 3 refused consent; therefore, 30 patients (mean [SD] age, 46.0 [18.6] years; 26 [86.7%] male) were recruited, with 15 randomized to receive BoNT and 15 to receive placebo. In the intention-to-treat group, the Fahn-Tolosa-Marin Tremor Rating Scale total score was significantly lower in the BoNT group at 6 weeks (adjusted mean difference, -10.9; 95% CI, -15.4 to -6.5; P < .001) and 12 weeks (adjusted mean difference, -5.7; 95% CI, -11.0 to -0.5; P = .03). More participants in the BoNT group reported global improvement on the Global Impression of Change (PGIC) assessment (PGIC 1,2, and 3: BoNT: 4 [26.7%], 6 [40.0%], and 5 [33.3%]; placebo: 5 [33.3%], 10 [66.7%], and 0, respectively; P = .047). Subjective hand weakness (BoNT: 6 [40.0%]; placebo: 4 [28.6%], P = .52) and dynamometer-assessed grip strength (mean difference, -0.2 log 10 [kgf/m 2 ] 2 / Hz-Hz; 95% CI, -0.9 to 0.4 log 10 [kgf/m 2 ] 2 /Hz-Hz; P = .45) were similar in both groups. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, botulinum neurotoxin injections were superior to placebo in reducing tremor severity in upper-extremity DT. An individualized approach to muscle selection and dosing was beneficial without unacceptable adverse effects.

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Section: Introductionmentioning

confidence: 99%

Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor

et al. 2021

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Positional Tremor and its Treatment

Schaefer

Hallett

Karp

et al. 2017

Movement Disord Clin Pract

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Background Positional tremors arise when a patient’s tremor is brought on during specific positioning of the involved body part. They can be distinguished from postural tremor, wherein a patient’s tremor is elicited in any posture, and from task-specific tremor, wherein a patient’s tremor occurs only during a certain task. Cases We describe two cases of positional tremor that are markedly improved with botulinum toxin injection. Discussion The term “positional” is a valuable descriptor for tremors. In patients with positional tremor, botulinum toxin may be beneficial for treatment. Lidocaine injection provides a transient way to test for the appropriateness of botulinum toxin injection in these patients.

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A Pilot Study of Botulinum Toxin for Jerky, Position-Specific, Upper Limb Action Tremor

Cited by 2 publications

References 14 publications

Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor

Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor

Positional Tremor and its Treatment

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