Objective: The aim of this study is to compare the efficacy of botulinum toxin (BoNT) injections in forearm flexors and extensor muscles versus pure flexors for the treatment of ET incorporating functional and global improvement scales.

Background: With 4% of the adult population over the age of 40 with ET, of whom only 40% respond to oral pharmacological therapy as well as complications of brain surgery, there is a great need in truly evaluating the benefit of other treatment in this condition. Mild-to-moderate efficacy of low-dose BoNT injections in the forearm muscles of patients with ET was in RCTs. However, to our knowledge there is a paucity of literature directly comparing the efficacy of BoNT injections in forearm flexor and extensor versus pure flexor muscles.

Methods: With 4% of the adult population over the age of 40 with ET, of whom only 40% respond to oral pharmacological therapy as well as complications of brain surgery, there is a great need in truly evaluating the benefit of other treatment in this condition. Mild-to-moderate efficacy of low-dose BoNT injections in the forearm muscles of patients with ET was in RCTs. However, to our knowledge there is a paucity of literature directly comparing the efficacy of BoNT injections in forearm flexor and extensor versus pure flexor muscles.

Results: Study is completed and results will be available at time of presentation. 21 patients (11 females; 10 males) were recruited. 1 patient was lost to follow up after initial injection. Preliminary data shows a mean improvement in patient global impact scale of 1.6 in each group. Grip strength decreased by 38% in group that received injections in both flexor and extensor compartments versus 30% decrease in flexor only compartment. Statistical significance pending.

Conclusions: From preliminary results, it does not appear there was a significant difference between the injection patterns and both arms had significant weakness measured by grip strength. However, statistical analysis is still pending and will be available upon presentation.

References: Abboud H, Ahmed A, Fernandez HH (2011) Essential tremor: choosing the right management plan for your patient. Cleve Clin J Med 78:821-828 doi: 10.3949/ccjm.78a.10178. Brin MF, Lyons KE, Doucette J, et al. (2001) A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology 56:1523-1528 Jankovic J, Schwartz K, Clemence W, Aswad A, Mordaunt J (1996) A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor. Mov Disord 11:250-256 doi: 10.1002/mds.870110306. Pacchetti C, Mancini F, Bulgheroni M, Zangaglia R, Cristina S, Sandrini G, Nappi G (2000) Botulinum toxin treatment for functional disability induced by essential tremor. Neurol Sci 21:349-353. Sadeghi R, Ondo WG (2010) Pharmacological management of essential tremor. Drugs 70:2215-2228 doi: 10.2165/11538180-000000000-00000. Simpson DM, Blitzer A, Brashear A, et al. (2008) Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 70:1699-1706 doi: 10.1212/01.wnl.0000311389.26145.95.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-botulinum-toxin-injections-in-forearm-flexor-and-extensor-muscles-versus-pure-flexor-muscles-for-the-treatment-of-essential-hand-tremor-flex-d-et/