Movement Disorders, Neurological Institute, Cleveland Clinic Abu Dhabi, AE.
London Movement Disorders Center, London, Ontario, CA.
Tremor Other Hyperkinet Mov (N Y). 2020 Dec 31;10:61. doi: 10.5334/tohm.582.
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.
The study includes detailed analysis of the techniques utilized in BoNT injection in ET and PD tremor.
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.
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.
帕金森病（PD）和特发性震颤（ET）引起的手震颤在临床实践中往往难以治疗。局部注射肉毒毒素 A（BoNT-A）治疗手震颤是一个不断发展的领域，新的注射技术在临床研究中得到了应用。然而，基于治疗后手指和手部无力的高发生率，BoNT-A 疗法对 ET 和 PD 震颤的疗效受到了质疑。
本研究详细分析了 BoNT 注射治疗 ET 和 PD 震颤的技术。
有 4 项高质量的研究，包括 I 类或 II 类双盲安慰剂对照试验和 1 项中等质量的前瞻性、开放标签、III 类研究。
本文讨论了两种最近开发的基于技术的 BoNT-A 治疗 ET 和 PD 震颤的注射方法，包括前臂和手臂肌肉的全面肌电图筛查和选择性注射（耶鲁方法）以及 Jog 等人开发的整个手臂运动学震颤评估。近年来，这些两种方法的对照、盲法研究显示，与以前未使用这些方法学的对照临床试验相比，手指、手和整个肢体震颤在注射后明显减少。
