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Botulinum Toxin for the Treatment of Hand Tremor
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Toxins 2018, 10(10), 394; https://doi.org/10.3390/toxins10100394

Transitioning from Unilateral to Bilateral Upper Limb Tremor Therapy for Parkinson’s Disease and Essential Tremor Using Botulinum Toxin: Case Series

1
Department of Clinical Neurological Sciences, London Health Sciences Centre—Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada
2
Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada
*
Author to whom correspondence should be addressed.
Received: 23 August 2018 / Revised: 20 September 2018 / Accepted: 22 September 2018 / Published: 27 September 2018
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Abstract

Botulinum toxin type A (BoNT-A) injections guided by kinematic analysis for unilateral upper limb essential tremor (ET) and Parkinson’s disease (PD) tremor therapy has demonstrated efficacy, improvements in quality of life (QoL) and arm functionality. In this open-label pilot trial, 5 ET and 2 PD participants decided to switch from receiving long-term unilateral arm treatment to now bilateral BoNT-A arm therapy in their other tremulous arm which worsened over time. Injection patterns were based on kinematic analysis. Efficacy endpoints including kinematic analysis, Fahn-Tolosa-Marin tremor rating scale, QoL questionnaire, and maximal grip strength were collected over 2 treatments and 2 follow-up visits totaling 18-weeks. BoNT-A decreased wrist tremor amplitude by 84.6% and 89.6% 6-weeks following the 1st injection in the newly-treated limb in ET and PD participants, respectively. PD participants started with worse QoL but demonstrated an additional improvement in QoL by 29.9% for switching to bilateral treatment, whereas ET participants did not. Left and right arm tremor also did not share commonalities in severity or dose. This preliminary finding suggests trends for transitioning to bilateral therapy and warrants further studies to evaluate efficacy of bilateral tremor BoNT-A therapy in a larger cohort of PD and ET patients. View Full-Text
Keywords: Parkinson’s disease; essential tremor; tremor; movement disorders; Botulinum toxin; kinematics; upper limb biomechanics; joint biomechanics; diagnostic guidance; clinical decision support Parkinson’s disease; essential tremor; tremor; movement disorders; Botulinum toxin; kinematics; upper limb biomechanics; joint biomechanics; diagnostic guidance; clinical decision support
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Samotus, O.; Lee, J.; Jog, M. Transitioning from Unilateral to Bilateral Upper Limb Tremor Therapy for Parkinson’s Disease and Essential Tremor Using Botulinum Toxin: Case Series. Toxins 2018, 10, 394.

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