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

Toxins
Olivia SamotusMandar Jog

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...Continue Reading

References

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May 14, 2005·Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists·Joy C MacDermid
Aug 17, 2005·Parkinsonism & Related Disorders·Alexander I TrösterKelly E Lyons
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Aug 22, 2015·Movement Disorders : Official Journal of the Movement Disorder Society·Alfonso Fasano, Günther Deuschl
Sep 1, 2015·Tremor and Other Hyperkinetic Movements·Elan D LouisCatherine Rice
Nov 11, 2017·Toxins·Elina Zakin, David Simpson
Jul 22, 2018·Toxins·Nicki Niemann, Joseph Jankovic

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Citations

Jan 25, 2020·Current Neuropharmacology·Hortensia Alonso-NavarroFélix J Jiménez-Jiménez
Oct 6, 2020·Therapeutic Advances in Neurological Disorders·Olivia SamotusMandar Jog
Jan 16, 2021·Clinical Neuropharmacology·Bekir Enes Demiryurek
Jan 13, 2021·Toxins·Charenya Anandan, Joseph Jankovic
Apr 14, 2020·Neurologic Clinics·William George Ondo

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Clinical Trials Mentioned

NCT02551848

Software Mentioned

Biometrics DataLINK
MatLab
CONSORT
SPSS

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