Botulinum toxin in essential hand tremor - a randomized double-blind placebo-controlled study with customized injection approach

Mittal, S.O.; Machado, D.; Richardson, D.; Dubey, D.; Jabbari, B.

Parkinsonism and Related Disorders 56: 65-69


ISSN/ISBN: 1873-5126
PMID: 29929813
DOI: 10.1016/j.parkreldis.2018.06.019
Accession: 052406356

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To evaluate the safety and efficacy of incobotulinumtoxinA (IncoA) injection for treatment of essential hand tremor. In essential tremor and Parkinson's disease tremor, administration of onabotulinumtoxinA via a fixed injection approach improves the tremor but a high percentage of patients (30-70%) develop moderate to severe hand weakness which has limited its use in clinical practice. This study was performed from July 2013 to July 2016 on 33 subjects. This is a double-blind, placebo-controlled, crossover trial injecting 80-120 units of IncoA into 8-14 hand and forearm muscles using a customized approach. The subjects were followed for 28 weeks. The treatment efficacy was evaluated by the Fahn Tolosa Marin tremor rating score and NIH genetic criteria for tremor severity at 4 and 8 weeks after each of the two sets of treatments. Hand strength was assessed by an ergometer. There was statistically significant improvement in clinical rating score of tremor at 4 and 8 weeks following the IncoA injection. In this study, injection of IncoA treatment via a customized approach improved essential tremor on the clinical scales and patient's perception with a low occurrence of significant hand weakness.