OBJECTIVE: To evaluate the safety and efficacy of botulinum toxin type A in disabling multiple sclerosis (MS)-related upper limb tremor. METHODS: Twenty-three patients with MS contributed data from 33 upper limbs to this study. Each limb was randomized in a crossover design to receive botulinum toxin type A or placebo at baseline and the reverse treatment at 12 weeks. The 3 main outcomes were the median changes in Bain tremor rating scores for tremor severity, writing, and drawing an Archimedes spiral from baseline to 6 and 12 weeks after treatment with botulinum toxin type A compared with those after treatment with saline placebo. An independent rater scored randomized video assessments performed every 6 weeks over 6 months. RESULTS: There was a significant improvement after botulinum toxin compared with that after placebo treatment in the Bain score for tremor severity at 6 weeks (p = 0.0005) and 12 weeks (p = 0.0001), writing at 6 weeks (p = 0.0001) and 12 weeks (p = 0.0003), and Archimedes spiral drawing at 6 weeks (p = 0.0006) and 12 weeks (p = 0.0002). More patients developed weakness after botulinum toxin treatment (42.2%) than after placebo injection (6.1%; (p = 0.0005). Weakness was mild (just detectable) to moderate (still able to use limb) and resolved within 2 weeks. CONCLUSIONS: Targeted botulinum toxin type A injections significantly improve arm tremor and tremor-related disability in patients with MS. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that targeted injection of botulinum toxin type A is associated with significant improvement in MS-related upper limb tremor.
RCT Entities:
OBJECTIVE: To evaluate the safety and efficacy of botulinum toxin type A in disabling multiple sclerosis (MS)-related upper limb tremor. METHODS: Twenty-three patients with MS contributed data from 33 upper limbs to this study. Each limb was randomized in a crossover design to receive botulinum toxin type A or placebo at baseline and the reverse treatment at 12 weeks. The 3 main outcomes were the median changes in Bain tremor rating scores for tremor severity, writing, and drawing an Archimedes spiral from baseline to 6 and 12 weeks after treatment with botulinum toxin type A compared with those after treatment with saline placebo. An independent rater scored randomized video assessments performed every 6 weeks over 6 months. RESULTS: There was a significant improvement after botulinum toxin compared with that after placebo treatment in the Bain score for tremor severity at 6 weeks (p = 0.0005) and 12 weeks (p = 0.0001), writing at 6 weeks (p = 0.0001) and 12 weeks (p = 0.0003), and Archimedes spiral drawing at 6 weeks (p = 0.0006) and 12 weeks (p = 0.0002). More patients developed weakness after botulinum toxin treatment (42.2%) than after placebo injection (6.1%; (p = 0.0005). Weakness was mild (just detectable) to moderate (still able to use limb) and resolved within 2 weeks. CONCLUSIONS: Targeted botulinum toxin type A injections significantly improve arm tremor and tremor-related disability in patients with MS. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that targeted injection of botulinum toxin type A is associated with significant improvement in MS-related upper limb tremor.
Authors: Carlo Alberto Artusi; Ashar Farooqi; Alberto Romagnolo; Luca Marsili; Roberta Balestrino; Leonard L Sokol; Lily L Wang; Maurizio Zibetti; Andrew P Duker; George T Mandybur; Leonardo Lopiano; Aristide Merola Journal: J Neurol Date: 2018-03-06 Impact factor: 4.849
Authors: Frederique Boonstra; Grace Florescu; Andrew Evans; Chris Steward; Peter Mitchell; Patricia Desmond; Brad Moffat; Helmut Butzkueven; Scott Kolbe; Anneke van der Walt Journal: J Neural Transm (Vienna) Date: 2017-11-02 Impact factor: 3.575