A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor

被引:149
作者
Brin, MF
Lyons, KE
Doucette, J
Adler, CH
Caviness, JN
Comella, CL
Dubinsky, RM
Friedman, JH
Manyam, BV
Matsumoto, JY
Pullman, SL
Rajput, AH
Sethi, KD
Tanner, C
Koller, WC
机构
[1] Univ Miami, Med Ctr, Dept Neurol, Miami, FL 33136 USA
[2] Columbia Univ, Dept Neurol, New York, NY USA
[3] Mt Sinai Med Ctr, Dept Community & Prevent Med, New York, NY 10029 USA
[4] Mayo Clin Scottsdale, Dept Neurol, Scottsdale, AZ USA
[5] Rush Presbyterian St Lukes Med Ctr, Dept Neurol, Chicago, IL 60612 USA
[6] Univ Kansas, Med Ctr, Dept Neurol, Kansas City, KS 66103 USA
[7] Brown Univ, Dept Neurol, Providence, RI 02912 USA
[8] Texas A&M Univ, Coll Med, Scott & White Clin, Dept Neurol, Temple, TX 76508 USA
[9] Mayo Clin, Dept Neurol, Rochester, MN USA
[10] Royal Univ Saskatoon, Dept Neurol, Saskatoon, SK, Canada
[11] Med Coll Georgia, Dept Neurol, Augusta, GA 30912 USA
[12] Parkinson Inst, Sunnyvale, CA USA
关键词
D O I
10.1212/WNL.56.11.1523
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To evaluate the safety and efficacy of botulinum toxin type A injection in essential tremor of the hand. Background: Botulinum toxin type A is an effective treatment for dystonia, spasticity, and other movement disorders and has been found to be useful in open-label studies and one double-masked study of essential hand tremor. Methods: One hundred thirty-three patients with essential tremor were randomized to low-dose (50 U) or high-dose (100 U) botulinum toxin type A (Botox) or vehicle placebo treatment. Injections were made into the wrist flexors and extensors. Patients were followed for 16 weeks. The effect of treatment was assessed by clinical rating scales, measures of motor tasks and functional disability, and global assessment of treatment. Hand strength was evaluated by clinical rating and by a dynamometer. Results: Both doses of botulinum toxin type A significantly reduced postural tremor on the clinical rating scales after 4 to 16 weeks. However, kinetic tremor was significantly reduced only at the g-week examination. Measures of motor tasks and functional disability were not consistently improved with botulinum toxin type A treatment. Grip strength was reduced for the low- and high-dose botulinum toxin type A groups as compared with the placebo group. Adverse reactions consisted mainly of dose-dependent hand weakness. Conclusion: Botulinum toxin type A injections for essential tremor of the hands resulted in significant improvement of postural, but not kinetic, hand tremors and resulted in limited functional efficacy. Hand weakness is a dose-dependent significant side effect of treatment at the doses used in this study.
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页码:1523 / 1528
页数:6
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