title: Effectiveness of BoNT A in Parkinson's disease upper limb tremor management.
abstract: OBJECTIVE
  One the greatest challenges of BoNT A therapy for tremor lies in the complexity and variation of components involved in tremor movement, and the lack of objective measures to determine these components. This 3 month open-label single injection study aims to couple clinician best judgment with kinematics to improve effect of BoNT A (incobotulinumtoxinA) injection in 7 patients with upper limb Parkinson's disease (PD) tremor.
  
  
  METHODS
  Injection was guided with clinical and kinematic assessment of tremor using angular wrist position in 3 degrees of freedom: flexion/extension, pronation/supination, and radial/ulnar deviation. Overall tremor severity and change were measured by linear finger acceleration.
  
  
  RESULTS
  Kinematic data from static and functional tasks demonstrate no improvement at one month post-injection, but significant improvement at two and three months. Clinical scales across UPDRS Items 20 (1, 2, 3 months post) and 21 (2 months), and spiral drawings (3 months) showed significant improvement from baseline, while line drawings did not.
  
  
  CONCLUSIONS
  This study suggests injection of BoNT A as a viable focal management option for upper limb PD tremor. In addition to clinical judgment, objective quantification of tremor dynamics by kinematics may be a feasible assessment and guidance tool which can be used to optimize injection conditions for focal tremor therapy. Kinematic analysis of tremor across a variety of joints in all degrees of movement may provide important insight into tremor dynamics, allowing optimized, targeted focal therapy.
authors: Department of Clinical Neurological Sciences, London Health Sciences Centre.
authors: Fariborz
authors: F
authors: Rahimi
authors: Carina
authors: C
authors: Bee
authors: Derek
authors: D
authors: Debicki
authors: Angela C
authors: AC
authors: Roberts
authors: Priya
authors: P
authors: Bapat
authors: Mandar
authors: M
authors: Jog
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014202:Tremor / Q000188:drug therapy* / Q000209:etiology*; D034941:Upper Extremity / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A