Gonul Oner Ozge, Erturk Cetin Ozdem, Serkan Demir
Department of Neurology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
Department of Neurology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
Clin Neuropharmacol. 2024;47(6):189-192. doi: 10.1097/WNF.0000000000000614. Epub 2024 Sep 17.
Multiple sclerosis (MS)-related tremor remains a disabling problem that often responds poorly to medical treatments. This study aims to evaluate the effect of botulinum toxin type A on MS-related upper limb tremor.
This retrospective observational cohort study included 8 patients who received intramuscular injections of onabotulinum toxin type A for medically refractory MS-related tremor. Hospital records before and 4-6 weeks after treatment, including the Fahn-Tolosa-Marin Tremor rating scale (FTM-TRS), electrophysiological tremor analysis, neurological examination findings, and videos, were reviewed retrospectively.
There was significant improvement after botulinum toxin injection in the FTM TRS part A score for tremor ( P = 0.011), FTM TRS part B score for hand function ( P = 0.011), FTM Part score for activities of daily living ( P = 0.012), and FTM TRS total score for overall evaluation ( P = 0.012). Electrophysiological tremor analysis revealed maximal tremor amplitudes between 700-2000 μV (before treatment) and between 300-1000 μV (after treatment). The mean tremor amplitudes before and after treatment were 1350 μV and 725 μV, respectively. No adverse reactions were observed after botulinum toxin treatment.
BoNT may improve upper limb tremor and functionality in MS-related tremor. The treatment involved administering BoNT under EMG guidance, with careful muscle selection based on clinical assessment and EMG findings. This approach aimed to optimize treatment efficacy while minimizing potential adverse effects. Further studies are warranted to confirm these findings.
与多发性硬化症（MS）相关的震颤仍然是一个致残性问题，通常对药物治疗反应不佳。本研究旨在评估A型肉毒毒素对MS相关上肢震颤的影响。
这项回顾性观察性队列研究纳入了8例因药物难治性MS相关震颤接受肌内注射A型肉毒毒素的患者。回顾性分析治疗前及治疗后4-6周的医院记录，包括法恩-托洛萨-马林震颤评定量表（FTM-TRS）、电生理震颤分析、神经学检查结果和视频。
肉毒毒素注射后，FTM TRS震颤部分A评分（P = 0.011）、FTM TRS手部功能部分B评分（P = 0.011）、FTM日常生活活动部分评分（P = 0.012）以及FTM TRS总体评估总分（P = 0.012）均有显著改善。电生理震颤分析显示，最大震颤幅度在治疗前为700-2000μV，治疗后为300-1000μV。治疗前后的平均震颤幅度分别为1350μV和725μV。肉毒毒素治疗后未观察到不良反应。
肉毒毒素可能改善MS相关震颤的上肢震颤和功能。治疗方法是在肌电图引导下注射肉毒毒素，并根据临床评估和肌电图结果仔细选择肌肉。该方法旨在优化治疗效果，同时将潜在不良反应降至最低。有必要进行进一步研究以证实这些发现。
