title: A double-blind, randomized, controlled study of botulinum toxin type A in MS-related tremor.
abstract: 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.
  
  
  METHODS
  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: Royal Melbourne Hospital, Melbourne, Australia. anneke.vanderwalt@mh.org.au
authors: Anneke
authors: A
authors: Van Der Walt
authors: Simon
authors: S
authors: Sung
authors: Timothy
authors: T
authors: Spelman
authors: Mark
authors: M
authors: Marriott
authors: Scott
authors: S
authors: Kolbe
authors: Peter
authors: P
authors: Mitchell
authors: Andrew
authors: A
authors: Evans
authors: Helmut
authors: H
authors: Butzkueven
mesh_terms: D000328:Adult; D001132:Arm / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome; D014202:Tremor / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D019274:Botulinum Toxins, Type A