Treatment of Dystonic Tremor of the Upper Limbs : A Single-Center Retrospective Study
González-Herrero, Belén (Universitat Autònoma de Barcelona. Departament de Medicina)
Di Vico, Ilaria Antonella (Department of Neurosciences Biomedicine and Movement Sciences, University of Verona)
Pereira, Erlick (St. George's University of London)
Edwards, Mark (King's College London)
Morgante, Francesca (Dipartimento di Medicina Clinica e Sperimentale, University of Messina, 98122 Messina, Italy)

Date:	2023
Abstract:	Tremor is part of the phenomenological spectrum of dystonia. Treatments available for tremor in dystonia are oral medications (OM), botulinum neurotoxin (BoNT), and brain surgery (deep brain stimulation or thalamotomy). There is limited knowledge regarding the outcome of different treatment options, and evidence is especially scarce for the tremor of the upper limbs occurring in people with dystonia. In this single-center retrospective study, we evaluated the outcome of different treatments in a cohort of people with upper limb dystonic tremors. Demographic, clinical, and treatment data were analyzed. Dropout rates and side effects were specifically assessed, as well as the 7-point patient-completed clinical global impression scale (p-CGI-S, 1: very much improved; 7: very much worse) as outcome measures. A total of 47 subjects (46. 8% female) with dystonic tremor, tremor associated with dystonia, or task-specific tremor were included, with a median age at onset of 58 years (7-86). A total of 31 subjects were treated with OM, 31 with BoNT, and 7 with surgery. Dropout rates with OM were 74. 2% due to either lack of efficacy (n = 10) or side effects (n = 13). A total of 7 patients treated with BoNT (22. 6%) had mild weakness, causing dropout in 2. P-CGI-S was ≤3 (improvement) in 39% with OM, compared to 92% with BoNT and 100% with surgery. These findings suggest good symptom control of the tremor of the upper limb in dystonia with BoNT and surgery, with higher rates of dropout and side effects with OM. Randomized controlled studies are needed to confirm our findings and provide further insight into better selecting suitable patients for BoNT or brain surgery.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Dystonia ; Tremor ; Dystonic tremor ; Botulinum toxin ; Deep brain stimulation
Published in:	Journal of clinical medicine, Vol. 12 (february 2023) , ISSN 2077-0383

DOI: 10.3390/jcm12041427
PMID: 36835960

10 p, 1.2 MB

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