Treatment of Primary Writing Tremor With Botulinum Toxin Type A Injections

Papapetropoulos, Spiridon; Singer, Carlos

doi:10.1097/01.wnf.0000236765.00785.9c

Cited by 37 publications

(26 citation statements)

References 12 publications

(13 reference statements)

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“…Botulinum neurotoxin (BoNT) injections have been employed in a total of 330 patients (8 studies) with PWT,33 head tremor43–46 or tremulous spasmodic dysphonia 47. As a consequence, its effectiveness in the management of these tremor disorders is well documented 48.…”

Section: Resultsmentioning

confidence: 99%

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The treatment of dystonic tremor: a systematic review

Fasano

Bove

Lang

2013

Journal of Neurology, Neurosurgery & Psychiatry

117

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Tremor is one of the clinical manifestations of dystonia; however, there are no specific therapeutic trials evaluating the efficacy of treatments for dystonic tremor (DT), tremor associated with dystonia or primary writing tremor (PWT). We systematically reviewed the literature available up to July 2013 on the treatment of these tremors and retrieved the data of 487 patients published in 43 papers detailing the effects of given interventions on tremor severity. Treatment outcome was highly variable, depending on the specific type of intervention and tremor distribution. No specifically designed studies were available for the treatment of tremor associated with dystonia. As for the other tremors, drug efficacy was generally disappointing and a moderate effect was only found with anticholinergics, tetrabenazine, clonazepam, β-blockers and primidone; levodopa was only efficacious on tremor due to dopa-responsive dystonia. The largest amount of data was available for botulinum toxin injections, which provided a marked improvement, particularly for the management of axial tremors (head or vocal cords). In refractory DTs, deep brain stimulation of several targets was attempted. Deep brain stimulation of globus pallidus internus, thalamus or subthalamic area led to a marked improvement of dystonic axial or appendicular tremors in most cases refractory to other treatments. Few other non-invasive treatments, for example, orthotic device in PWT, have been used with anecdotal success. In conclusion, considering the lack of good-quality studies, future randomised controlled trials are needed. In absence of evidence-based guidelines, we propose an algorithm for the treatment of DT based on currently available data.

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Section: Resultsmentioning

confidence: 99%

“…Task-specific jaw tremor has been found to improve after BoNT injections into the digastric and masseter muscles 16. Fewer studies on PWT are available and BoNT has been reported to be successful in some of them 33. No conclusion can be drawn about the efficacy of BoNT in patients with arm tremor not caused by PWT, as no case has been reported.…”

Section: Resultsmentioning

confidence: 99%

The treatment of dystonic tremor: a systematic review

Fasano

Bove

Lang

2013

Journal of Neurology, Neurosurgery & Psychiatry

117

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“…Some authors have reported PWT to be responsive to propranolol, primidone and alcohol, suggesting that the disorder may be more likely a variant of ET (2,5,6,(8)(9)(10). Conversely, other investigators have described patients responsive to botulinum toxin type A (BoNT-A) and anticholinergic medications and have suggested that PWT may be a form of dystonia (14,18,19). However, patients with tremor, such as Parkinson's tremor, can also be responsive to BoNT-A, as well as anticholinergic agents.…”

Section: Discussionmentioning

confidence: 99%

“…Medical treatment with anticholinergic agents, primidone and propranolol can be effective in up to 60% of patients, but the side effects from the medications can be limiting (1). Some authors have reported success with BoNT-A in small numbers of patients, but the resultant hand weakness can be troubling and disabling (3,4,11,14,15,20,21). The surgical treatment of PWT with deep brain stimulation may offer an alternative to those patients with significant medically refractory PWT.…”

Section: Discussionmentioning

confidence: 99%

Primary writing tremor responds to unilateral thalamic deep brain stimulation

Lyons

Shneyder²,

Evidente³

2011

Turkish Neurosurgery

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Primary writing tremor is a task associated tremor which occurs during and interferes with handwriting. Considered in most cases to be a nonprogressive disorder, a number of patients are significantly debilitated by the disease. The pathophysiology of the disorder is not fully understood, but felt to represent a variant of either essential tremor or dystonia versus a separate entity. Treatment has been limited to medications, writing devices and botulinum toxin type A for most patients. Recently, deep brain stimulation has been reported in a few patients as an effective option for those patients with medically refractory symptoms. We report our experience in a patient with primary writing tremor who underwent successful thalamic deep brain stimulation, discuss the current theories on the pathophysiology of the disorder and review the current literature of deep brain stimulation for refractory primary writing tremor. KeywOrds: Primary writing tremor, Deep brain stimulation, Thalamus ÖZPrimer yazma tremoru elle yazma sırasında oluşan ve bu işlemi olumsuz etkileyen, işlemle ilişkili bir tremordur. Çoğu vakada nonprogresif bir bozukluk olduğu düşünülmektedir ama bazı hastalar bu hastalık nedeniyle ciddi maluliyet durumu yaşar. Bozukluğun patofizyolojisi tam olarak anlaşılmamaktadır, ama ayrı bir antite yerine esansiyel tremor veya distoninin bir varyantı olduğu düşünülmektedir. Tedavi çoğu hastada ilaçlar, yazmaya yardımcı cihazlar ve botulinum toksini tip A ile sınırlıdır. Son zamanlarda derin beyin stimülasyonu tıbben refrakter belirtileri olan bazı hastalarda etkili bir seçenek olarak bildirilmiştir. Başarılı talamik derin beyin stimülasyonu yapılan bir primer yazma tremorlu hastayla deneyimimizi bildiriyor, bozukluğun patofizyolojisiyle ilgili mevcut teorileri açıklıyor ve refrakter primer yazma tremoru için derin beyin stimülasyonuyla ilgili güncel literatürü gözden geçiriyoruz.AnAhtAr sÖZCÜKler: Primer yazma tremoru, Derin beyin stimülasyonu, Talamus

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“…Enjeksiyon olgulara göre de¤iflmek üzere fleksör karpi ulnaris, ekstensör karpi ulnaris, ekstensör karpi radialis, ekstensör digitorum kommunis ve abduktor polisis longus kaslar›na 10-12.5 MU Botox ® dozunda uygulanm›flt›r. Hastalar enjeksiyondan belirgin fayda gördüklerin bildirmifllerdir (13).…”

Section: Primer Yazma Tremoruunclassified

Tremor Tedavisinde Botulinum Toksini

Tokçaer¹

2011

Npa

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A AB BS ST TR RA AC CT T Tremor is one of the most frequently encountered involuntary movement disorders in clinical practice. The causes of tremor are heterogeneous, therefore, a unique approach to the management of tremor is not available. Drug management of tremor is sometimes effective, however, there are subtypes of tremor such as dystonic tremor, primary writing tremor, voice tremor and essential head tremor, which are unresponsive to oral medication. The observation of marked amelioration of severity of tremor accompanying dystonia after botulinum toxin type A (BoNT) injection suggests that BoNT can be an alternative treatment option for tremor. In this review, our aim was to summarize the published literature on BoNT treatment for different subtypes of tremor. (Archives of Neuropsychiatry 2010; 47 Supplement: 35-9)

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Treatment of Primary Writing Tremor With Botulinum Toxin Type A Injections

Cited by 37 publications

References 12 publications

The treatment of dystonic tremor: a systematic review

The treatment of dystonic tremor: a systematic review

Primary writing tremor responds to unilateral thalamic deep brain stimulation

Tremor Tedavisinde Botulinum Toksini

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