Effectiveness of Botulinum Toxin on Hand Tremor Intensity and Upper Limb Function in Patients with Parkinson's Disease: Results of a Systematic Review

Fariba Eslamian; Neda Dolatkhah; Leila Fallah; Fatemeh Jahanjoo; Vahideh Toopchizadeh; Mahnaz Talebi

doi:10.5334/tohm.773

Effectiveness of Botulinum Toxin on Hand Tremor Intensity and Upper Limb Function in Patients with Parkinson's Disease: Results of a Systematic Review

Tremor Other Hyperkinet Mov (N Y). 2023 Aug 24:13:27. doi: 10.5334/tohm.773. eCollection 2023.

Authors

Fariba Eslamian¹, Neda Dolatkhah¹, Leila Fallah², Fatemeh Jahanjoo^{3

4}, Vahideh Toopchizadeh¹, Mahnaz Talebi⁵

Affiliations

¹ Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
² Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
⁴ Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany.
⁵ Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: Hand tremor is a common symptom of Parkinson's disease (PD). Tremors may be resistant to drug treatments. Therefore, Botulinum toxin (BoNT) could be a good alternative. This study aimed to review and analyze studies on the efficacy and safety of BoNT injection in hand tremor intensity and upper limb function in patients with idiopathic PD.

Methods: A comprehensive search was conducted for studies on the effect of local BoNT injections on tremors in PD patients from 1990 to December 2021. Electronic databases such as Cochrane Central Control Records, PubMed, Scopus, Web of Science, EMBASE, Google Scholar, Clinicaltrial.gov, ProQuest, Science Direct, CINAHL, and Psychoinfo were searched systematically.

Results: Ten studies, comprising one double-blinded randomized clinical trial and nine pilot open-labeled studies with 131 participants, met eligibility criteria. The reported tremor intensity ranged from 1 to 3, and the average tremor duration of 5.93 ± 2.08 years. The injectable dose was 68-100 units of onabotulinum-toxin-A in each upper limb muscle, mostly wrist flexors. The results showed a decrease in unified Parkinson's disease rating scale (UPDRS)_20 and UPDRS_21 indices by 1.22 ± 1.1 and 1.20 ± 0.9, respectively, without causing severe side effects. The BoNT relative effectiveness in the forearm and arm muscles was reported 6-16 weeks after injection.

Discussion: The kinematic, electromyography-guided, and electrical stimulation evaluations allow for accurate muscle localization and minimize the possibility of BoNT diffusion and antibody formation. More extensive randomized clinical trials with uniform measurement criteria are recommended to reduce bias and provide more accurate conclusions.

Highlight: Tremor treatment in Parkinson's-disease (PD) is challenging. Drugs effect is temporary, and surgery is critical management. This study reviews the Botulinum-toxin injection efficacy in hand tremor intensity and upper limb function. The results showed a decrease in unified Parkinson's disease rating scale (UPDRS)_20 and UPDRS_21 by 1.22 ± 1.1 and 1.20 ± 0.9, respectively, 6-16 weeks after injection.

Keywords: Botulinum toxin; Parkinson’s disease; Tremor; the unified Parkinson’s disease rating scale.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Databases, Factual
Forearm
Humans
Parkinson Disease* / complications
Parkinson Disease* / drug therapy
Randomized Controlled Trials as Topic
Tremor / drug therapy
Tremor / etiology
Upper Extremity

Grants and funding

This study was supported financially by the Evidence-Based Medicine (EBM) Research Center.