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Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics

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.
Toxins 2019, 11(2), 125; https://doi.org/10.3390/toxins11020125
Received: 1 February 2019 / Revised: 17 February 2019 / Accepted: 18 February 2019 / Published: 19 February 2019
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Abstract

Variability of multi-joint essential tremor (ET) between patients and within the two upper limbs makes a visual assessment for the determination of botulinum toxin type A (BoNT-A) injections challenging. Kinematic tremor analysis guidance has succeeded in overcoming this challenge by making effective long-term unilateral BoNT-A injections for disabling ET. In this open-label study, 31 ET participants received three bilateral arm BoNT-A injection cycles over 30 weeks with follow-ups six-weeks post-treatment. Whole-arm kinematic assessment of tremor using a customized, automated algorithm provided muscle selection and dosing per muscle without clinician’s assessment. Efficacy endpoints included Fahn-Tolosa-Marin tremor scale, quality of life (QoL) questionnaire, and maximum grip strength. BoNT-A reduced tremor amplitude by 47.7% in both the arms at week-6 (p < 0.005) that persisted from weeks 18–30. QoL was improved by 26.5% (p < 0.005) over the treatment period. Functional interference due to tremor was reduced by 30% (p < 0.005) from weeks 6–30. Maximum grip strength was reduced at week 6 (p = 0.001) but was not functionally impaired for the participants. Effective bilateral ET therapy by personalized BoNT-A injections could be achieved using computer-assisted tremor analysis. By removing variability inherent within the clinical assessments, this standardized tremor analysis method enabled patients to have improved bimanual upper limb functionality after the first treatment. View Full-Text
Keywords: movement disorders; essential tremor; functional disability; Botulinum toxin; kinematic tremor analysis; computer-assisted; biomechanics movement disorders; essential tremor; functional disability; Botulinum toxin; kinematic tremor analysis; computer-assisted; biomechanics
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Samotus, O.; Lee, J.; Jog, M. Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics. Toxins 2019, 11, 125.

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