Botulinum Toxin Injections for Essential Voice Tremor

Hertegård, Stellan; Granqvist, Svante; Lindestad, Per‐Åke

doi:10.1177/000348940010900216

Cited by 93 publications

(80 citation statements)

References 23 publications

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“…For each parameter, there are ordinarily 3 domains of analysis that use different bandwidths of Fourier analysis: (1) wow, from 0.1-to 2-Hz modulations; (2) tremor, from 2-to 10-Hz modulations; and (3) flutter, modulations from 10 to 20 Hz. The modulogram is preferable to the measures used in previous tremor treatment studies 18,22 because a wide range of specific modulation frequencies can be examined distinctly.…”

Section: Methodsmentioning

confidence: 99%

Botulinum Toxin Type A for Treating Voice Tremor

Adler¹,

Bansberg²,

Hentz³

et al. 2004

Arch Neurol

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Background: Voice tremor, like spasmodic dysphonia and other tremor disorders, may respond to botulinum toxin type A injections.Objective: To evaluate the safety and efficacy of botulinum toxin type A injections as treatment for voice tremor.Design: A randomized study of 3 doses of botulinum toxin type A with 6 weeks of follow-up.Setting: A single-site tertiary care center.Participants and Methods: Thirteen subjects (11 women, 2 men; mean age, 73 years) with voice tremor and no spasmodic dysphonia or head, mouth, jaw, or facial tremor were entered into this study. Patients received 1.25 U (n = 5), 2.5 U (n = 5), or 3.75 U (n=3) of botulinum toxin type A in each vocal cord. All patients were evaluated at baseline and postinjection at weeks 2, 4, and 6. Main Outcome Measures:The primary outcome measure was the patient tremor rating scale, with secondary measures including patient-rated functional disability, response rating scale, independent randomized tremor ratings, and acoustical measures.Results: All patients at all dose levels noted an effect from the injection. The mean time to onset of effect was 2.3 days (range, 1-7 days). For all patients combined, mean tremor severity scale scores (rated by patients on a 5-point scale) improved 1.4 points at week 2, 1.6 points at week 4, and 1.7 points at week 6. Measures of functional disability, measures of the effect of injection, independent ratings of videotaped speech, and acoustic measures of tremor also showed improvement. The main adverse effects at all doses were breathiness and dysphagia. Conclusion:Voice tremor improves following injections of botulinum toxin type A.

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Section: Methodsmentioning

confidence: 99%

Botulinum Toxin Type A for Treating Voice Tremor

Adler¹,

Bansberg²,

Hentz³

et al. 2004

Arch Neurol

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“…74 Another study (n ϭ 15) found a 67% self-report of benefit following BTX injections. 75 Eighty percent of patients reported breathy, weak voices for 1 to 2 weeks, while 20% had hoarseness and swallowing difficulties for 4 weeks.…”

Section: Do Patients With Et Benefit From Chemodenervation With Botulmentioning

confidence: 96%

“…73 Two class III studies using blinded voice analysis evaluated the effects of BTX A on voice tremor. 74,75 In one study, 30% of patients (3 of 10) demonstrated an objective reduction in tremor severity with bilateral injection into the vocal cords, compared to 22% of those who received unilateral injection. 74 Another study (n ϭ 15) found a 67% self-report of benefit following BTX injections.…”

Section: Do Patients With Et Benefit From Chemodenervation With Botulmentioning

confidence: 99%

Practice Parameter: Therapies for essential tremor [RETIRED]

et al. 2005

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Abstract-Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.

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“…Multiple studies have examined the effectiveness of these injections (Adler, Bansberg, Hentz, Ramig, Buder, Witt, et. al., 2004;Hertegard, Granqvist, & Lindestad, 2000;Christy L. Ludlow, Sedory, Fujita, & Naunton, 1989; with approximately 74% of participants experiencing an improvement in symptoms of vocal tremor following the injection; however, results can vary from injection to injection and some individuals do not show improvement following the injection.…”

mentioning

confidence: 99%

“…Further studies, with a greater number of participants, may be able to determine whether particular structures or (Bove, et al, 2006;Sulica & Louis, 2010;. Some studies have utilized laryngoscopy (Hertegard, et al, 2000;Koda & Ludlow, 1992;Klotz et al, 2004), but have focused assessment on the true vocal folds, failing to assess tremor in other structures near the larynx, and especially, missing tremor in the velopharynx. Other studies (Brown & Simonson, 1963;Hachinski et al, 1975;Massey & Paulson, 1985) have reported no tremor in the true vocal folds, but failed to have patients phonate during the assessment.…”

mentioning

confidence: 99%