Dynamic Decomposition of Motion in Essential and Parkinsonian Tremor

Rahimi, Fariborz; Debicki, Derek; Roberts, Angela; Bee, Carina; Bapat, Priya; Jog, Mandar

doi:10.1017/cjn.2015.12

Cited by 13 publications

(20 citation statements)

References 35 publications

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“…At present, literature on PD tremor injection with BoNT A has not shown similar success as with essential tremor. Supporting evidence from previous tremor analysis data suggest that PD tremor is multi-component, especially compared with eT 21 . However, most studies of focal hand tremor emphasize only the injection of flexor and extensor muscle groups.…”

Section: Discussionsupporting

confidence: 78%

“…Tremor is complex, especially in the upper extremity, and its manifestation can change depending on posture, task, and body part 21 . Parkinson disease tremor is often described as "pillrolling"; however, this tremor is not isolated to the fingers.…”

Section: Effectiveness Of Bont a In Parkinson's Disease Upper Limb Trmentioning

confidence: 99%

“…elbow), the direction of the predominant movement (e.g. extension), and the relative contributions of combinations of muscles to the overall tremor must be characterized 21 . Currently, characterization is done entirely on the basis of visual inspection and "gestalt" of the injector.…”

Section: Effectiveness Of Bont a In Parkinson's Disease Upper Limb Trmentioning

confidence: 99%

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Effectiveness of BoNT A in Parkinson's Disease Upper Limb Tremor Management

Rahimi

Bee

Debicki

et al. 2013

Can. J. Neurol. Sci.

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Abstract:Objective:One the greatest challenges of BoNT A therapy for tremor lies in the complexity and variation of components involved in tremor movement, and the lack of objective measures to determine these components. This 3 month open-label single injection study aims to couple clinician best judgment with kinematics to improve effect of BoNT A (incobotulinumtoxinA) injection in 7 patients with upper limb Parkinson's disease (PD) tremor.Methods:Injection was guided with clinical and kinematic assessment of tremor using angular wrist position in 3 degrees of freedom: flexion/extension, pronation/supination, and radial/ulnar deviation. Overall tremor severity and change were measured by linear finger acceleration.Results:Kinematic data from static and functional tasks demonstrate no improvement at one month post-injection, but significant improvement at two and three months. Clinical scales across UPDRS Items 20 (1, 2, 3 months post) and 21 (2 months), and spiral drawings (3 months) showed significant improvement from baseline, while line drawings did not.Conclusions:This study suggests injection of BoNT A as a viable focal management option for upper limb PD tremor. In addition to clinical judgment, objective quantification of tremor dynamics by kinematics may be a feasible assessment and guidance tool which can be used to optimize injection conditions for focal tremor therapy. Kinematic analysis of tremor across a variety of joints in all degrees of movement may provide important insight into tremor dynamics, allowing optimized, targeted focal therapy.

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Section: Discussionsupporting

confidence: 78%

Section: Effectiveness Of Bont a In Parkinson's Disease Upper Limb Trmentioning

confidence: 99%

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Effectiveness of BoNT A in Parkinson's Disease Upper Limb Tremor Management

Rahimi

Bee

Debicki

et al. 2013

Can. J. Neurol. Sci.

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“…As clinical examination is commonly insufficient, kinematic analysis can measure and display accurate tremor amplitude readings aiding clinicians to correctly target muscles contributing to tremor in the arm, unique to each patient [28,29]. Rahimi and colleagues demonstrated that analyzing wrist tremor movements visually (clinical assessment by experienced injector) and objectively (using kinematics) produced a 36% and 53% agreement in muscle selection in ET and PD participants, respectively [30]. This demonstrated the low agreement between clinical and objective assessments and highlighted the inherent difference between these assessment techniques.…”

Section: Discussionmentioning

confidence: 99%

Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections

2017

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ObjectiveCurrent pharmacological agents used to treat Parkinson disease (PD) tremor and essential tremor (ET) provide suboptimal benefit and are commonly associated with significant adverse effects. Botulinum toxin type A (BoNT-A) has been shown to be effective for wrist tremor though functionally bothersome muscle weakness frequently occurs. This is the longest study to date demonstrating that BoNT-A therapy coupled with kinematic guidance can provide efficacious outcomes for upper limb tremor with minimized unwanted weakness.MethodsA total of 28 PD and 24 ET participants with bothersome, disabling tremor, received six serial BoNT-A treatments every 16 weeks starting at week 0 with a follow-up visit 6 weeks following a treatment, totaling 96 weeks. Clinical scales, including Fahn-Tolosa-Marin tremor rating scale (FTM), and sensor-based tremor assessments were conducted at each visit. Kinematics was utilized to identify which arm muscles contributed to the tremulous movements and the experienced injector used clinical expertise in determining BoNT-A dosages.ResultsFollowing BoNT-A treatment, clinical ratings of tremor severity and functional ability (FTM) showed significant improvements following the first treatment which was maintained up to week 96 in PD and ET. Kinematics detected a significant reduction in PD and ET tremor amplitudes by 70% and 76% over the treatment course, respectively. By objectively distinguishing tremulous muscles and tremor severity, adverse effects were limited to mild perceived weakness by participants in injected muscles during follow-ups. Following the fourth treatment, BoNT-A dosages in flexor and extensor wrist muscles and biceps were reduced for those experiencing residual weakness which ultimately did not interfere with tremor relief or arm function.ConclusionsKinematics is an objective method that can aid clinicians in assessing and determining optimal BoNT-A parameters to alleviate both PD and ET tremor. BoNT-A injections are tolerable and effective when focal therapy regimens are determined and optimized kinematically over a long-term.

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“…Thus, the lack of adequate tremor assessment tools and poor injection guidelines have limited the use of BoNT-A for ET. [14][15][16] The use of well-established kinematic technology for tremor characterization is a reliable and feasible methodology and can be used to accurately pinpoint tremulous muscle groups for BoNT-A therapy. 13,15,17,18 Thus, kinematics provides an individualized multijoint movement pattern that can reduce the likelihood of dose-dependent weakness and thereby improve the functional efficacy of BoNT-A for ET.…”

Section: Introductionmentioning

confidence: 99%