Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor - the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment.

Bahman Jabbari,Shivam Om Mittal,Mandar Jog,Jack Lee

doi:10.5334/tohm.582

Abstract

Background:Hand tremor associated with Parkinson disease (PD) and essential tremor (ET) can often become challenging to treat in clinical practice. Local injections of botulinum toxin-A (BoNT-A) for hand tremor is an evolving field with newer injection techniques being utilized in clinical studies. The utility of BoNT-A therapy for ET and PD-tremor however, has been questioned based on the high incidence of finger and hand weakness after treatment.Method:The study includes detailed analysis of the techniques utilized in BoNT injection in ET and PD tremor.Results:There were 4 high-quality investigations which consisted of Class I or II double-blind placebo-controlled trials and one medium-quality study that was a prospective, open label, class III investigation.Discussion:This paper discusses two recently developed technology-based injection methods for BoNT-A therapy of ET and PD tremor, which includes comprehensive EMG screening of forearm and arm muscles with selective injections (Yale method) and the whole arm kinematic tremor assessment developed by Jog et al. In recent years, controlled, blinded studies of these two methods have shown significant post-injection reduction of finger, hand and whole limb tremor compared to the previously published controlled clinical trials not using these methodologies.

Highlights

Tremor is described as involuntary rhythmic oscillations due to muscular contractions [1]
The conclusion of this study indicated significantly improved upper limb functionality in Botulinum neurotoxins (BoNTs)-injected patients who had whole arm tremor and were examined with the computer-assisted tremor method to aid in the planning of the initial treatment pattern
On the other hand, based on the single class I study on Parkinson disease (PD) tremor conducted by the Yale group [15], BoNT-therapy could be regarded as “probably” effective for treatment of individuals with PD

Summary

Introduction

Tremor is described as involuntary rhythmic oscillations due to muscular contractions [1]. 30% of PD tremor patients are refractory to dopamine treatment and the tremor does not improve even with higher dose of dopaminergic medications. The utility of BoNT-A therapy for ET and PD-tremor has been questioned based on the high incidence of finger and hand weakness after treatment. Discussion: This paper discusses two recently developed technology-based injection methods for BoNT-A therapy of ET and PD tremor, which includes comprehensive EMG screening of forearm and arm muscles with selective injections (Yale method) and the whole arm kinematic tremor assessment developed by Jog et al In recent years, controlled, blinded studies of these two methods have shown significant post-injection reduction of finger, hand and whole limb tremor compared to the previously published controlled clinical trials not using these methodologies

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