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Effectiveness of BoNT A in Parkinson's Disease Upper Limb Tremor Management

Published online by Cambridge University Press:  23 September 2014

Fariborz Rahimi ,
Carina Bee ,
Derek Debicki ,
Angela C. Roberts ,
Priya Bapat  and
Mandar Jog
Fariborz Rahimi*
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre
Carina Bee
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre
Derek Debicki
Affiliation:
Department of Neurology, Western University, London, Ontario, Canada
Angela C. Roberts
Affiliation:
Department of Health Rehabilitation Sciences, Western University, London, Ontario, Canada
Priya Bapat
Affiliation:
Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
Mandar Jog
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre Department of Neurology, Western University, London, Ontario, Canada
*
London Health Sciences Centre, Department of Clinical Neurological Sciences, 339 Windermere Road, A10-026, London, Ontario, N6A 5A5, Canada. Email: fariborz.rahimi@gmail.com
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Abstract:

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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.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 5 , September 2013 , pp. 663 - 669
Copyright
Copyright © The Canadian Journal of Neurological 2013

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