Department of Clinical Neurological Sciences, London Health Sciences Centre-Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada.
Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, Canada.
Toxins (Basel). 2019 Feb 19;11(2):125. doi: 10.3390/toxins11020125.
Variability of multi-joint essential tremor (ET) between patients and within the two upper limbs makes a visual assessment for the determination of botulinum toxin type A (BoNT-A) injections challenging. Kinematic tremor analysis guidance has succeeded in overcoming this challenge by making effective long-term unilateral BoNT-A injections for disabling ET. In this open-label study, 31 ET participants received three bilateral arm BoNT-A injection cycles over 30 weeks with follow-ups six-weeks post-treatment. Whole-arm kinematic assessment of tremor using a customized, automated algorithm provided muscle selection and dosing per muscle without clinician's assessment. Efficacy endpoints included Fahn-Tolosa-Marin tremor scale, quality of life (QoL) questionnaire, and maximum grip strength. BoNT-A reduced tremor amplitude by 47.7% in both the arms at week-6 ( < 0.005) that persisted from weeks 18⁻30. QoL was improved by 26.5% ( < 0.005) over the treatment period. Functional interference due to tremor was reduced by 30% ( < 0.005) from weeks 6⁻30. Maximum grip strength was reduced at week 6 ( = 0.001) but was not functionally impaired for the participants. Effective bilateral ET therapy by personalized BoNT-A injections could be achieved using computer-assisted tremor analysis. By removing variability inherent within the clinical assessments, this standardized tremor analysis method enabled patients to have improved bimanual upper limb functionality after the first treatment.
多关节原发性震颤（ET）在患者之间以及两个上肢内的变异性使得确定肉毒毒素 A 型（BoNT-A）注射变得具有挑战性。运动震颤分析指导通过对致残性 ET 进行有效且长期的单侧 BoNT-A 注射，成功克服了这一挑战。在这项开放标签研究中，31 名 ET 参与者在 30 周内接受了三轮双侧手臂 BoNT-A 注射周期，并在治疗后 6 周进行随访。使用定制的自动化算法对整个手臂震颤进行运动学评估，无需临床医生评估即可为每个肌肉选择和给药。疗效终点包括 Fahn-Tolosa-Marin 震颤量表、生活质量（QoL）问卷和最大握力。BoNT-A 在第 6 周时使双臂震颤幅度降低了 47.7%（<0.005），并持续到第 18-30 周。在治疗期间，QoL 提高了 26.5%（<0.005）。从第 6 周到第 30 周，由于震颤引起的功能干扰减少了 30%（<0.005）。最大握力在第 6 周（=0.001）下降，但对参与者没有造成功能损害。使用计算机辅助震颤分析可以实现个性化 BoNT-A 注射对双侧 ET 的有效治疗。通过消除临床评估中固有的变异性，这种标准化的震颤分析方法使患者在第一次治疗后能够改善双手臂的上肢功能。
