Abstract
Effective Management of Upper Limb Parkinsonian Tremor by IncobotulinumtoxinA Injections Using Sensor-based Biomechanical Patterns
Highlights
Tremor is a cardinal sign of Parkinson’s disease (PD) and is one of the most challenging symptoms to treat
For PD patients with tremor as their only troublesome symptom, treatment with current oral medications becomes a therapeutic dilemma as these drugs may contribute to motor fluctuations and dyskinesia later in life
Trosch and Pullman18 demonstrated in an open label study that five of the 10 PD patients moderately improved in clinical tremor scores, accelerometry measures for rest tremor did not significantly change
Summary
Tremor is a cardinal sign of Parkinson’s disease (PD) and is one of the most challenging symptoms to treat. Focal treatment of Parkinson’s disease tremor by botulinum toxin type A incobotulinumtoxinA (BoNT-A) injections has been inadequately investigated and at best provides modest relief with significant muscle weakness. Complexity of multi-joint tremulous movements results in non-individualized dosing regimens This 38-week open-label study used kinematic technology to guide muscle selection and improve efficacy of incobotulinumtoxinA (BoNT-A) injections for Parkinson’s disease tremor. Clinical tremor scales, the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Fahn–Tolosa–Marin (FTM), and kinematic assessments were conducted. Injection parameters were determined using the clinician’s interpretation of which muscles would contribute to the upper limb tremor biomechanics analyzed kinematically. Discussion: Kinematics is a simple method for standardizing assessments and treatment of upper limb Parkinson’s disease tremor, thereby personalizing tremor therapy and optimizing the effect of BoNT-A injections for Parkinson’s disease tremor
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