Abstract
The aim of this study is to review our longitudinal experience with onabotulinumtoxinA (onaBoNT-A) injections for medically refractory hand tremor. We performed a retrospective review of our database of patients treated with onaBoNT-A for hand tremor evaluated between 2010 and 2018 in at least 2 sessions with follow-up. The majority were injected into the forearm flexors (FF), although treatment was individualized. During the specified period, 91 patients (53 essential tremor, 31 dystonic tremor, 6 Parkinson’s disease tremor, and 1 cerebellar outflow tremor) met our inclusion criteria. The mean age (SD) was 64.8 years (12.8), and mean duration of follow-up was 29.6 months (25.1) with mean of 7.7 (6.3) treatment visits. FF were injected in 89 (97.8%) patients, exclusively in 74 (81.3%), and 15 (16.5%) were injected in FF and other muscles. EMG guidance was used in 5 patients (5.5%). On a 0–4 “peak effect” rating scale (0 = no effect, 4 = marked improvement in severity and function), 80.2% and 85.7% of patients reported moderate or marked improvement (score 3 or 4) at their first and last follow-up visit, respectively. There was no statistically significant difference in the outcomes between first and last visit: average “peak effect” rating score (3.2 versus 3.4), “global” rating score (3.0 versus 3.2), latency of response (4.5 versus 3.8 days), and total duration of response (12.7 versus 12.8 weeks), except onaBoNT-A dose (65.0 versus 78.6 U/limb, p = 0.002). Of 1095 limb injections, there were 134 (12.2%) non-disabling and transient (mean 36 days) adverse events (132 limb weakness, 2 pain). OnaBoNT-A injections are safe and effective in the treatment of hand tremor.
Highlights
Tremor is defined as an involuntary, rhythmic, oscillatory movement of a body part [1]
We identified a total of 91 patients who were treated with onaBoNT-A for hand tremor at least identified a total of 91 patients who treated with for to hand at least twice andWe had adequate follow-up during thewere period from
For hand tremor over an average period of 2.5 years. This is the longest duration of follow-up data reported regarding the use of Botulinum toxin (BoNT) for hand tremor, we previously reported our long-term experience with BoNT in the treatment of dystonia over a period of more than 20 years [19]
Summary
Tremor is defined as an involuntary, rhythmic, oscillatory movement of a body part [1]. Hand tremor is a common movement disorder, often associated with impairment in quality of life [2]. Essential tremor (ET) is the most common cause of postural and kinetic hand tremor; 4.6% of individuals 65 years or older are thought to have ET [3]. Parkinson’s disease (PD) affects 0.43–1.90% of individuals 60 years or older [4] with the majority experiencing rest or postural tremor [5,6]. There are many other causes of tremor besides ET, PD, and dystonia, which can affect hands and other body parts [1].
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