Objective: This was a 24-week open-label study to assess the role of BoNT-A injections for various types of hand and head tremor

Background: Focal treatment of head and upper extremities (U.E) tremor by onabotulinumtoxin-A (BoNT-A) injections has been inadequately investigated. Though few reports showed modest effects, yet, the absence of large-scale studies, heterogeneous tremor presentation, and diverse regimens to target a multi-joint tremulous movement make it difficult to reach an objective consensus regarding its value

Method: Participants (n=37) attended Kasr Alaini Movement Disorder Unit (KA-MDU) with UE or head tremor were undergone US-guided BoNT-A injection using tri-axial accelerometeric sensors to measure upper limb and head kinematics and in which axes of the sensors were aligned with the main joint axes in U.E and on splenii, trapezius and SCM in the neck. All patients performed an electromyography (EMG) assessment. Study visits were scheduled at weeks 2, 4, 12, 16, 20, and 24 (data-lock visits). During each visit, Fahn-Tolosa-Marin (FTM) tremor motor scale was conducted for ET, and for PD tremor UPDRS item 20 (rest tremor) was applied. All patients were subjected to videotaping with Standard Scripted Tasks (during rest, posture and motion) and SF-36 QoL questionnaire. Injection doses were determined according to tremor frequency and severity. Re-injection was done whenever needed at weeks 16 or 20

Results: A significant decrease in FTM tremor severity score at week 6 (p< 0.01) with improvement in QoL questionnaire (P<0.05). In PD tremor, though some improvement was detected, yet, it was not statistically significant (P=0.06). Head tremor showed statistically significant improvement compared to those with limb tremor (P=0.04). Muscle weakness was detected in 4/25 patients with limb tremor

Conclusion: The use of objective kinematic assessment of limb and head tremor (motion sensors) can allow a precise directional assessment of tremor at each arm joint allowing for a better outcome

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-a-in-head-and-upper-extremities-tremor-a-hand-made-option/