title: Comparative effectiveness of propranolol and botulinum for the treatment of essential voice tremor.
abstract: OBJECTIVE
  To assess the comparative effectiveness of botulinum toxin and propranolol in patients with essential vocal tremor (EVT).
  
  
  METHODS
  Individual prospective cohort study.
  
  
  METHODS
  Study patients were recruited at the Emory Voice Center from patients seeking treatment for EVT. Exclusion criteria included current β-blocker treatment, spasmodic dysphonia, or other disease that prevented the use of propranolol therapy. A 10-week washout period from prior botulinum toxin treatment occurred before enrollment. Patients were assessed via the Voice-Related Quality-Of-Life (VRQOL) questionnaire, Quality of life in Essential Tremor questionnaire, and blinded perceptual voice assessment. These assessments were made at baseline voice 2 weeks after propranolol therapy and 4 weeks after botulinum toxin injection.
  
  
  RESULTS
  Eighteen patients were enrolled. After 2 to 4 weeks of propranolol therapy (with a maximum dosage of 60 mg to 90 mg per day), patients report an average ΔVRQOL of 9.31. Six patients report significant VRQOL improvement >10, with the rest reporting changes between -7.5 and 7.5. Fifteen patients were followed for at least 4 weeks after botulinum toxin injection, reporting an average improvement in scaled VRQOL of 22.00. Blinded perceptual voice assessment demonstrates an improvement in overall severity of tremor with botulinum toxin.
  
  
  CONCLUSIONS
  In some patients with EVT, propranolol led to significant vocal improvement with no major side effects. Although botulinum toxin remains the gold-standard therapy for patients with EVT, propranolol represents a possible alternative or adjuvant therapy for certain patients.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Justicz
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Edie R
authors.initials: ER
authors.lastname: Hapner
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Josephs
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Boone
authors.affiliation: Departments of Neurology, Human Genetics & Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
authors.forename: Hyder A
authors.initials: HA
authors.lastname: Jinnah
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D055154:Dysphonia / Q000188:drug therapy*; D020329:Essential Tremor / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D009465:Neuromuscular Agents; D011433:Propranolol; D019274:Botulinum Toxins, Type A
keywords: Propranolol; botulinum; essential vocal tremor