Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor - the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment

Abstract

Background: Hand tremor associated with Parkinson disease (PD) and essential tremor (ET) can often become challenging to treat in clinical practice. Local injections of botulinum toxin-A (BoNT-A) for hand tremor is an evolving field with newer injection techniques being utilized in clinical studies. The utility of BoNT-A therapy for ET and PD-tremor however, has been questioned based on the high incidence of finger and hand weakness after treatment.

Method: The study includes detailed analysis of the techniques utilized in BoNT injection in ET and PD tremor.

Results: There were 4 high-quality investigations which consisted of Class I or II double-blind placebo-controlled trials and one medium-quality study that was a prospective, open label, class III investigation.

Discussion: This paper discusses two recently developed technology-based injection methods for BoNT-A therapy of ET and PD tremor, which includes comprehensive EMG screening of forearm and arm muscles with selective injections (Yale method) and the whole arm kinematic tremor assessment developed by Jog et al. In recent years, controlled, blinded studies of these two methods have shown significant post-injection reduction of finger, hand and whole limb tremor compared to the previously published controlled clinical trials not using these methodologies.

Keywords: Botulinum neurotoxin; Botulinum toxin; Essential tremor; Parkinson disease tremor; Tremor; incobotulinumtoxinA; onabotulinumtoxinA.

Figure 1

Review of Literature and the studies included.

Figure 2

Timeline of the Botulinum toxin in Essential Tremor and Parkinson’s disease tremor.