Personalized injection approaches result in the improvement of tremor severity with lower rates of muscle weakness, as muscles contributing to tremor are injected with dosages that are based on the severity of the tremulous movements. Objective techniques to personalize injection pattern determination include using kinematic technology that measures the severity (selection of dose) and the contribution of tremor in all the upper limb joints (selection of muscles) or using the Yale method that involves measuring rhythmic burst potentials of electromyographic (EMG) activity, and the dose is based on the activity and size of the muscle. Botulinum toxin type A (BoNT-A) as a targeted tremor therapy holds promise when personalizing injection patterns (selection of muscle and dose) to the characteristics of an individual’s tremor. Approximately 30% of PD patients are refractory to DRT, and 60% of ET patients discontinue oral medications due to failure to alleviate tremor and side effects. Oral medications, such as beta blockers for ET patients and dopaminergic replacement therapy (DRT) for PD patients, provide suboptimal benefit. Upper-limb tremor often interferes with daily activities, impacts social lifestyles, and reduces the quality of life in essential tremor (ET) and Parkinson’s disease (PD) patients. This suggests that kinematics could be used by a non-expert to attain equivalent efficacy potentially improving access to this treatment.
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Conclusions: Kinematic-based BoNT-A injections produced similar treatment outcomes to injections based on the clinical expertise of the expert injector. Discontinuation due to no benefit/weakness was not dependent on the injection pattern determination approach. Double reconstitution of Xeomin ® in the wrist flexors/extensors, supinator, biceps, and triceps were most injected. BoNT-A as a monotherapy in both upper limbs was received in more ET than PD patients.
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Results: Mean age (72 ± 9 years), number of injections (5), years receiving therapy (~2 years), clinic- (~57%) or kinematic-based patterns, and self-paying (52%) were similar between both cohorts.
![tremulous hinge tremulous hinge](http://thewonderchildblog.com/wp-content/uploads/2021/03/maharah-looking-strong-231x300.jpg)
A Mann–Whitney U statistical test was used to compare outcome measures between ET and PD cohorts. Demographics of patients and BoNT-A injections were collected. Methods: 68 ET and 45 PD patients received at least one injection for their upper-limb tremor (unilateral or bilateral) in the last 7 years. This retrospective study aims to review our clinical outcomes of treating essential tremor (ET) and Parkinson’s disease (PD) tremor using either clinical- or kinematic-based injection pattern determination methods. However, it is unclear in real-world practices whether a technology-guided approach can compare with expert clinical assessments (including surface anatomy and palpation) for improving outcomes. Background: Botulinum toxin type A (BoNT-A) therapy for upper-limb tremor has emerged as a promising option.