A double-blind, randomized, controlled study of botulinum toxin type A in MS-related tremor.

Abstract

OBJECTIVE:

To evaluate the safety and efficacy of botulinum toxin type A in disabling multiple sclerosis (MS)-related upper limb tremor.

METHODS:

Twenty-three patients with MS contributed data from 33 upper limbs to this study. Each limb was randomized in a crossover design to receive botulinum toxin type A or placebo at baseline and the reverse treatment at 12 weeks. The 3 main outcomes were the median changes in Bain tremor rating scores for tremor severity, writing, and drawing an Archimedes spiral from baseline to 6 and 12 weeks after treatment with botulinum toxin type A compared with those after treatment with saline placebo. An independent rater scored randomized video assessments performed every 6 weeks over 6 months.

RESULTS:

There was a significant improvement after botulinum toxin compared with that after placebo treatment in the Bain score for tremor severity at 6 weeks (p = 0.0005) and 12 weeks (p = 0.0001), writing at 6 weeks (p = 0.0001) and 12 weeks (p = 0.0003), and Archimedes spiral drawing at 6 weeks (p = 0.0006) and 12 weeks (p = 0.0002). More patients developed weakness after botulinum toxin treatment (42.2%) than after placebo injection (6.1%; (p = 0.0005). Weakness was mild (just detectable) to moderate (still able to use limb) and resolved within 2 weeks.

CONCLUSIONS:

Targeted botulinum toxin type A injections significantly improve arm tremor and tremor-related disability in patients with MS.

CLASSIFICATION OF EVIDENCE:

This study provides Class III evidence that targeted injection of botulinum toxin type A is associated with significant improvement in MS-related upper limb tremor.

• Authors: Anneke Van Der Walt, Simon Sung, Timothy Spelman, Mark Marriott, Scott Kolbe, Peter Mitchell, Andrew Evans, Helmut Butzkueven
• Journal: Neurology (Neurology) Vol. 79 Issue 1 Pg. 92-9 (Jul 03 2012) ISSN: 1526-632X [Electronic] United States
• PMID: 22753445 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Botulinum Toxins, Type A

Topics

• Adult
• Arm (physiopathology)
• Botulinum Toxins, Type A (therapeutic use)
• Cross-Over Studies
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Multiple Sclerosis (drug therapy, epidemiology, physiopathology)
• Treatment Outcome
• Tremor (drug therapy, epidemiology, physiopathology)