Treatment of Dystonic Tremor of the Upper Limbs

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,...

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Autores: González-Herrero, Belén|||0000-0003-2579-1497, Di Vico, Ilaria Antonella, Pereira, Erlick, Edwards, Mark J, Morgante, Francesca|||0000-0002-9834-3639
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:272457
Acceso en línea:https://ddd.uab.cat/record/272457
https://dx.doi.org/urn:doi:10.3390/jcm12041427
Access Level:acceso abierto
Palabra clave:Dystonia
Tremor
Dystonic tremor
Botulinum toxin
Deep brain stimulation
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spelling Treatment of Dystonic Tremor of the Upper LimbsA Single-Center Retrospective StudyGonzález-Herrero, Belén|||0000-0003-2579-1497Di Vico, Ilaria AntonellaPereira, ErlickEdwards, Mark JMorgante, Francesca|||0000-0002-9834-3639DystoniaTremorDystonic tremorBotulinum toxinDeep brain stimulationTremor 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. 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/272457https://dx.doi.org/urn:doi:10.3390/jcm12041427reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest 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.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2724572026-06-06T12:50:31Z
dc.title.none.fl_str_mv Treatment of Dystonic Tremor of the Upper Limbs
A Single-Center Retrospective Study
title Treatment of Dystonic Tremor of the Upper Limbs
spellingShingle Treatment of Dystonic Tremor of the Upper Limbs
González-Herrero, Belén|||0000-0003-2579-1497
Dystonia
Tremor
Dystonic tremor
Botulinum toxin
Deep brain stimulation
title_short Treatment of Dystonic Tremor of the Upper Limbs
title_full Treatment of Dystonic Tremor of the Upper Limbs
title_fullStr Treatment of Dystonic Tremor of the Upper Limbs
title_full_unstemmed Treatment of Dystonic Tremor of the Upper Limbs
title_sort Treatment of Dystonic Tremor of the Upper Limbs
dc.creator.none.fl_str_mv González-Herrero, Belén|||0000-0003-2579-1497
Di Vico, Ilaria Antonella
Pereira, Erlick
Edwards, Mark J
Morgante, Francesca|||0000-0002-9834-3639
author González-Herrero, Belén|||0000-0003-2579-1497
author_facet González-Herrero, Belén|||0000-0003-2579-1497
Di Vico, Ilaria Antonella
Pereira, Erlick
Edwards, Mark J
Morgante, Francesca|||0000-0002-9834-3639
author_role author
author2 Di Vico, Ilaria Antonella
Pereira, Erlick
Edwards, Mark J
Morgante, Francesca|||0000-0002-9834-3639
author2_role author
author
author
author
dc.subject.none.fl_str_mv Dystonia
Tremor
Dystonic tremor
Botulinum toxin
Deep brain stimulation
topic Dystonia
Tremor
Dystonic tremor
Botulinum toxin
Deep brain stimulation
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2
2023-01-01
2023
2023-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/272457
https://dx.doi.org/urn:doi:10.3390/jcm12041427
url https://ddd.uab.cat/record/272457
https://dx.doi.org/urn:doi:10.3390/jcm12041427
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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