Objective: To show that botulinum toxin injections guided by EMG polygraphic recording is effective to improve  proximal upper limbs tremor.

Background: Holmes tremor is highly disabling, there is no effective medical therapy and use of botulinum toxin injections has had mixed results.

Method: We analyzed upper limb muscles involved in the tremor from surface electromyographic polygraphic recording to guide the strategy of botulinum toxin injection. Electromyographic examination was conducted at rest, with postures holdings and with tasks (spiral drawing…). This resulted in a tremor scale (from 0 to 3) in each activity achieving an average for each upper limb muscles. Patients were evaluated before injection and a month later to assess the effectiveness and tolerance of treatment. Outcome measures included modified Fahn Tolosa Marin tremor rating scale (FTMm) and a patient centered functionnal scale (COPM…).

Results: Eleven patients were included in the study (8 female and 3 men). The majority (82%) had multiple sclerosis. The tremor was present for an average of 8 years. Our study shows the involvement of the deltoid muscle in the tremor of the upper limb and our work shows a significant decrease of tremor after one month on the FTMm ( 50.6 ± 4.32 ; 43,2 ± 4,59; p=0.042) and on upper extremity-specific clinical rating (16 ± 6.0; 11 ± 5.7; p= 0.043) without significant modification of the COPM. One patient developed slight weakness of shoulder abduction.

Conclusion: The current findings support the effectivness of injection of botulinum toxin guided by electromyographic polygraphic recording in the treatment of Holmes tremor.

References: [1] Kim, Samuel D., Con Yiannikas, Neil Mahant, Steve Vucic, et Victor S.C. Fung. « Treatment of proximal upper limb tremor with botulinum toxin therapy ». Movement Disorders 29, no 6 (2014) : 835-38; [2] Van Der Walt, A, S Sung, T Spelman, M Marriott, S Kolbe, P Michell, A Evans, et H Butzkueven. « A double-blind, randomized, controlled study of botulinum toxin type A in MS-related tremor. » Neurology 79, no 1 (7 2012) : 92-99.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/holmes-tremor-contribution-of-botulinum-toxin-injection-strategy-guided-by-electromyographic-emg-polygraphic-recording/