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Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study.

González-Herrero, B; Di Vico, IA; Pereira, E; Edwards, M; Morgante, F (2023) Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study. J Clin Med, 12 (4). p. 1427. ISSN 2077-0383 https://doi.org/10.3390/jcm12041427
SGUL Authors: Morgante, Francesca

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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.

Item Type: Article
Additional Information: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Keywords: botulinum toxin, deep brain stimulation, dystonia, dystonic tremor, tremor, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: J Clin Med
ISSN: 2077-0383
Language: eng
Dates:
DateEvent
10 February 2023Published
7 February 2023Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 36835960
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/115213
Publisher's version: https://doi.org/10.3390/jcm12041427

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