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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics
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Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics

机译：肉毒杆菌毒素型注射作为使用运动学的上肢基本震颤的单药治疗

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Background: There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters. Methods: Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics. Results: There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48. Conclusions: Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.
机译：背景：对于必要的震颤（ET）有重大需要，因为没有专门用于ET的药物，并且规定的药物通常不受耐受，因此许多患者仍未治疗。最近的工作表明，与以前的经验不同，运动学上的胞质肉毒杆菌毒素类型A（逆向A）注射提供益处以及最小的弱点。我们的是使用运动学驱动的注入参数的第一个长期（96周）的逆向者作为单药治疗的安全性和疗效研究。方法：每16周给予六个序列患者六个序列末端治疗，并在治疗后6周评估。在每次学习访问期间，Fahn-Tolosa-Marin（FTM）规模，统一的帕金森病评级规模和基本震颤问卷（任务）的生活质量以及对治疗的肢体的运动评估。参与者使用放置在每个臂接头上的运动传感器进行脚本任务。使用运动障碍神经科医生对肌肉的解释来确定给药模式，促进运动学上肢体震颤生物力学的贡献。结果：在第96周，在第96周，虽然有44.6％（ P <0.0005）最大抓握强度的非剂量依赖性降低，只有2名参与者抱怨轻度弱点。第四次序列处理后，平均动作震颤分数在治疗中减少62.9％（p = 0.001），并在第96周的未处理臂中达到44.4％（p = 0.03）。结论：个性化的怪人-A每个人的震颤生物力学的给药模式为ET提供了有效的单一疗法，因为功能改善而无需功能下限地限制肌肉无力。

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