A Pilot Study of Botulinum Toxin for Jerky, Position-Specific, Upper Limb Action Tremor

Tabish A. Saifee; Tiago Teodoro; Roberto Erro; Mark J. Edwards; Carla Cordivari

doi:10.5334/tohm.292

Figures & Tables

Table 1

Clinical Characteristics

ID	Sex	Age	P. Hand	UL Involvement by Tremor			Other	Previous Treatments/Response	Injection Strategy
ID	Sex	Age	P. Hand	Side (R/L)	Segments Affected	Rest (R), Postural (P), Kinetic (K)	Other	Previous Treatments/Response	Muscles/Dose	Total Dose
1	F	71	L	L	S, A, H	R, P, K	Head tremor; unsteady gait (stable)	PRO, TPM, GBP, PMD/NR, IT	Left: T min 80, Infraspin 80, L dorsi 80	240
2	M	76	R	R	S, A, F	P, K	Nil	Nil	Right: Infraspin 80, Sup 30, ECR 30, P teres 40, Deltoid 20	200
3	M	71	R	L>R	S, A, F	P, K	Nil	Unknown/NR	Right: Infraspin 50, P teres 50, Sup 50, P quadratus 50	200
3	M	71	R	L>R	S, A, F	P, K	Nil	Unknown/NR	Left: Infraspin 50, P major 50, Subscapularis 100, P teres 50, P quadratus 50, Sup 50	350
4	F	69	R	L>R	S, A>F	P, K	Nil	Unknown/NR	Right: Infraspin 100, P major 100, Trapezius 100	300
4	F	69	R	L>R	S, A>F	P, K	Nil	Unknown/NR	Left: Infraspin 100, P major 100, Trapezius 100	300
5	M	61	R	R>L	S, A, F	R, P, K	Head tremor	PRO/NR, IT	Right: P quadratus 20, Supraspin 40, T major 100, P teres 50	210
6	M	51	R	R>L	F>H, A, S	P, K	Nil	Nil	Right: P teres 60, P quadratus 40, Sup 40	140
7	M	43	R	R = L	H, F>S, A	R, P, K	Nil	Nil	Right: FC ulnaris: 120, EC radialis 40	160
8	F	75	R	R	F>S, A	P, K	Mild cervical dystonia	Nil	Right: Sup 40, P teres 30, P quadratus 40, Infraspin 80	190
Median (IQR)		70 (56–73)								205 (190–300)

[i] Abbreviations: A, Arm; ECR, Extensor Carpi Radialis; F, Forearm; FC ulnaris, Flexor Carpi Ulnaris; GBP, Gabapentin; H, Hand; Infraspin, Infraspinatus; IT, Intolerance; L dorsi, Latissimus Dorsi; NR, Non-response; Other, Other Neurological Problems; PRM, Primidone; PRO, Propranolol; P. hand, Preferred Hand; P major, Pectoralis Major; P quadratus, Pronator Quadratus; P teres, Pronator Teres; S, Shoulder; Sup, Supinator; Supraspin, Supraspinatus; T min, Teres Minor; TPM, Topiramate; UL, Upper Limb.

[ii] Dosage is in units of Dysport^®.

Table 2

Outcomes

ID	Follow-up (weeks)	Side	Global Clinical Impression	Upper Limb CRS for Tremor Subscore		Improvement in Specific Activities of Daily Living	Adverse events
ID	Follow-up (weeks)	Side	Global Clinical Impression	B	F	Improvement in Specific Activities of Daily Living	Adverse events
1	3.7	L	3	5	5	None	Marked shoulder weakness
2	3	R	4	2	0	BLM	Mild shoulder weakness
3	6	R	4	5	3	BLM (mild)	None
3	6	L	4	6	6	BLM (mild)	None
4	6	R	5	3	1	Feeding and BLM	Mild weakness
4	6	L	5	6	5	Feeding and BLM	Mild weakness
5	5	R	5	6	3	Feeding, BLM, shaving, dressing	None
6	3.6	R	4	4	2	Feeding (mild)	None
7	3.6	R	3	4	4	None	None
8	6	R	4	4	2	None	None
Median (IQR)	4.4 (3.6–6)		4 (3.5–4.5)	4.5 (4–6)	3 (2–5)

[i] Abbreviations: B, Baseline; BLM, Bringing Liquids to Mouth; CRS, Clinical Rating Scale; F, Follow-up; IQR, Interquartile Range; L, Left; R, Right.

[ii] Clinical global impression: much improved (5), improved (4), no change (3), worse (2), much worse (1).