Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor – the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment

Mittal, Shivam Om; Jog, Mandar; Lee, John; Jabbari, Bahman

doi:10.5334/tohm.582

Cited by 18 publications

(14 citation statements)

References 26 publications

(56 reference statements)

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“…The utility of BTX-A therapy for ET and PD tremor has been questioned based on the high incidence of finger and hand weaknesses after the treatment due to the injection method. However, this side effect has been overcome after the introduction of new methods, like the Yale protocol and the computerized kinematic tremor assessment, which produced significantly less weakness compared to previously reported methods [ 83 , 84 , 87 ].…”

Section: Essential Tremor (Et)mentioning

confidence: 99%

The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models

Kosmowska

Wardas

2021

Biomolecules

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Essential tremor (ET) is one of the most common neurological disorders that often affects people in the prime of their lives, leading to a significant reduction in their quality of life, gradually making them unable to independently perform the simplest activities. Here we show that current ET pharmacotherapy often does not sufficiently alleviate disease symptoms and is completely ineffective in more than 30% of patients. At present, deep brain stimulation of the motor thalamus is the most effective ET treatment. However, like any brain surgery, it can cause many undesirable side effects; thus, it is only performed in patients with an advanced disease who are not responsive to drugs. Therefore, it seems extremely important to look for new strategies for treating ET. The purpose of this review is to summarize the current knowledge on the pathomechanism of ET based on studies in animal models of the disease, as well as to present and discuss the results of research available to date on various substances affecting dopamine (mainly D3) or adenosine A1 receptors, which, due to their ability to modulate harmaline-induced tremor, may provide the basis for the development of new potential therapies for ET in the future.

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Section: Essential Tremor (Et)mentioning

confidence: 99%

The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models

Kosmowska

Wardas

2021

Biomolecules

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“…The reported success rate is variable and is influenced by factors such as dose, muscles selected, technique, and provider experience [92][93][94]. The Yale Technique and Sensor-Based Kinematics have been proposed as safe and supportive methods that can enhance efficacy [95]. The Sensor-Based Kinematics method uses motion sensors to analyze angular tremor amplitude, which provides better individualized muscle selection [94,95].…”

Section: Botulinum Toxin Injectionsmentioning

confidence: 99%

“…The Yale Technique and Sensor-Based Kinematics have been proposed as safe and supportive methods that can enhance efficacy [95]. The Sensor-Based Kinematics method uses motion sensors to analyze angular tremor amplitude, which provides better individualized muscle selection [94,95]. The Yale Technique uses EMG guidance of determined muscles to further enhance accurate muscle selection and success rate [95].…”

Section: Botulinum Toxin Injectionsmentioning

confidence: 99%

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Tremor in Parkinson’s Disease: From Pathophysiology to Advanced Therapies

Abusrair

Elsekaily

Bohlega

2022

Tremor and Other Hyperkinetic Movements

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Background: Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremordominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD.Methods: A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years. Discussion:The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its longterm efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are noninvasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.

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“…There are three techniques for BoNT injection in tremor conditions, manual palpation alone, EMG screening (Yale technique), or the computerized kinematic analysis [50]. Clinical examination of the tremulous muscles and injection of BoNT based on surface landmarks and muscle palpation is preferred by a few experienced injectors.…”

Section: Clinical Examination and Injection Techniquesmentioning

confidence: 99%