Combined triaxial accelerometeric sensors and ultrasonography-guided botulinum toxin type-A injection can improve outcome in upper extremities tremor in multiple sclerosis
Author(s): ,
H. Shehata
Neurology Department
N. Shalaby
Neurology Department
M. Basheer
Neurophysiology Department, Cairo University, Cairo, Egypt
M. Abdel-Naseer
Neurology Department
ECTRIMS Online Library. Shehata H. Oct 12, 2018; 228161
Hatem Shehata
Hatem Shehata
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Abstract: P1783

Type: Poster Sessions

Abstract Category: N/A

Background: Focal treatment of upper extremities (UE) tremor by onabotulinumtoxin-A (BoNT-A) injections in multiple sclerosis (MS) has been inadequately investigated. Though few reports showed modest effects; yet, absence of large scale studies, heterogeneous tremor presentation and diverse regimens to target a multi-joint tremulous movement make it difficult to reach an objective consensus regarding its value.
Objective: This was a 24-week open-label study to assess the role of BoNT-A injections in disabling MS-related upper limb tremor.
Methods: Participants (n=34) with resistant to treat UE tremors attended study visits at weeks 0, 2, 4, 12, 16, 20 and 24 (data-lock visit). During each visit patients were subjected to standardized videotaping (during rest, posture and motion), tremor assessment using Fahn-Tolosa-Marin (FTM) tremor motor scale and Archimedes spiral drawings. BoNT-A injection was determined using surface EMG (tremor frequency) and ultrasonography of muscles that may contribute to the tremor across a variety of joints in all degrees of movement using tri-axial accelerometeric sensors to measure UE kinematics and in which axes of the sensors were aligned with the main joint axes. Re-injection was done whenever needed at weeks 16 or 20.
Resuls: A significant decrease in FTM tremor severity score and Archimedes spiral drawing at week 4 (p< 0.01, P=0.002 respectively) and at week 12 (P=0.03, P=0.06 respectively). Re-injection was done for 7 patients with continuous satisfactory response. Muscle weakness was detected in 3/34 patients with limb tremor, which was mild and transient (resolved within 2 weeks).
Conclusion: BoNT-A could be a promising option for improving resistant to treat UE tremor in MS using a multi technical approach for directional assessment of tremor at each arm joint.
Disclosure: nothing to disclose

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