Objective: To study the effect of BoNT injections on tremor in patients with upper limb dystonia with hand tremor.

Background: Tremor is a common accompaniment of dystonia that has suboptimal response to medications. Botulinum toxin (BoNT) injections are effective in cervical dystonic tremor, there is limited evidence on the effect of BoNT injections on upper limb dystonia with tremor.

Method: We conducted a prospective, open label study including patients with upper limb dystonia and tremor (dystonic tremor, essential tremor plus). Participants received electromyographically (EMG) guided BoNT injections in the upper limb muscles using a customized approach with individualised muscle and dose selection. Fahn-Tolosa-Marin Tremor rating scale (TRS) and combined accelerometry-EMG tremor analysis were done at baseline and at 6 weeks post-injection. Participants were monitored for adverse events and reported subjective global improvement on a 4-point Likert scale.

Results: We recruited 10 participants. Baseline total TRS score was 33.0±13.5. At 6-weeks post injection, the total TRS (p=0.003) and upper extremity subscore (p=0.016) were significantly improved. Total power of tremor spectrum on accelerometry showed trend towards improvement (p=0.059).  Subjective global improvement was reported by 8/10 participants, despite transient hand muscle weakness reported by 5/10.

Conclusion: EMG guided, individualised BoNT injections can be a treatment option for patients with upper limb dystonia and tremor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-injections-for-upper-limb-dystonia-with-tremor/