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Toxins (Basel). 2019 Feb 19;11(2). pii: E125. doi: 10.3390/toxins11020125.

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

Author information

1
Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada. osamotus@uwo.ca.
2
Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada. osamotus@uwo.ca.
3
Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada. jack.lee@lhsc.on.ca.
4
Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada. mandar.jog@lhsc.on.ca.
5
Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada. mandar.jog@lhsc.on.ca.

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.

KEYWORDS:

Botulinum toxin; biomechanics; computer-assisted; essential tremor; functional disability; kinematic tremor analysis; movement disorders

PMID:
30791440
DOI:
10.3390/toxins11020125
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