Kreisler Alexandre, Bouchain Benoîte, Defebvre Luc, Krystkowiak Pierre
Neurologie et Pathologie du Mouvement, CHU Lille, Lille, FR.
Neurologie, CHU Amiens, Amiens, FR.
Tremor Other Hyperkinet Mov (N Y). 2019 Jul 26;9. doi: 10.7916/tohm.v0.640. eCollection 2019.
Botulinum neurotoxin's degree of effectiveness on upper limb tremor is subject to debate; although this treatment reduces the tremor's amplitude, a clear functional benefit has not been demonstrated. The objective of this study was to assess the effect of botulinum neurotoxin type A treatment on activities of daily living and quality of life in patients with upper limb tremor.
We retrospectively examined the medical records of 50 consecutive patients treated with botulinum neurotoxin for upper limb tremor that was refractory to oral medication. One month after the injection, the patient was evaluated according to the Quality of Life in Essential Tremor Questionnaire, and the Essential Tremor Embarrassment Assessment.
Full data sets were available for 38 patients suffering variously from essential tremor ( = 21), Holmes tremor secondary to a focal brain lesion (n = 8), idiopathic dystonic tremor (n = 4), primary writing tremor (n = 4), and Parkinson's disease (n = 1). The Quality of Life Essential Tremor Questionnaire and the Essential Tremor Embarrassment Assessment scores improved significantly (p < 0.001) in the study population as a whole, and in the essential tremor and Holmes tremor subgroups.
Botulinum neurotoxin treatment of patients with upper limb tremor is associated with improved quality of life and activities of daily living, irrespective of the tremor's etiology. Long-term treatment enables the physician to adjust the injection strategy to the patient's needs. Our study was limited by its retrospective design. The results must therefore be confirmed in a prospective, double-blind, placebo-controlled, randomized clinical trial.
肉毒杆菌神经毒素对上肢震颤的有效性程度存在争议；尽管这种治疗可降低震颤幅度，但尚未证明有明显的功能益处。本研究的目的是评估A型肉毒杆菌神经毒素治疗对上肢震颤患者日常生活活动能力和生活质量的影响。
我们回顾性研究了50例连续接受肉毒杆菌神经毒素治疗上肢震颤且口服药物治疗无效的患者的病历。注射后1个月，根据原发性震颤生活质量问卷和原发性震颤尴尬评估对患者进行评估。
38例患者有完整数据集，这些患者分别患有原发性震颤（n = 21）、局灶性脑病变继发的霍姆斯震颤（n = 8）、特发性肌张力障碍性震颤（n = 4）、原发性书写震颤（n = 4）和帕金森病（n = 1）。总体研究人群以及原发性震颤和霍姆斯震颤亚组的原发性震颤生活质量问卷和原发性震颤尴尬评估得分均有显著改善（p < 0.001）。
肉毒杆菌神经毒素治疗上肢震颤患者可改善生活质量和日常生活活动能力，无论震颤的病因如何。长期治疗使医生能够根据患者需求调整注射策略。我们的研究受其回顾性设计的限制。因此，结果必须在前瞻性、双盲、安慰剂对照、随机临床试验中得到证实。
