Effective Management of Upper Limb Parkinsonian Tremor by IncobotulinumtoxinA Injections Using Sensor-based Biomechanical Patterns
Identifieur interne : 000746 ( Main/Exploration ); précédent : 000745; suivant : 000747Effective Management of Upper Limb Parkinsonian Tremor by IncobotulinumtoxinA Injections Using Sensor-based Biomechanical Patterns
Auteurs : Fariborz Rahimi [Iran] ; Olivia Samotus [Canada] ; Jack Lee [Canada] ; Mandar Jog [Canada]Source :
- Tremor and Other Hyperkinetic Movements [ 2160-8288 ] ; 2015.
Abstract
Focal treatment of Parkinson’s disease tremor by botulinum toxin type A incobotulinumtoxinA (BoNT-A) injections has been inadequately investigated and at best provides modest relief with significant muscle weakness. Complexity of multi-joint tremulous movements results in non-individualized dosing regimens. This 38-week open-label study used kinematic technology to guide muscle selection and improve efficacy of incobotulinumtoxinA (BoNT-A) injections for Parkinson’s disease tremor.
Participants (n=28) attended study visits at weeks 0, 6, 16, 22, 32, and 38, and were injected with BoNT-A at weeks 0, 16, and 32. During each visit, clinical tremor scales, the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Fahn–Tolosa–Marin (FTM), and kinematic assessments were conducted. Participants performed rest and postural scripted tasks with motion sensors placed over the wrist, elbow, and shoulder joints where tremor was quantified by angular root mean square (RMS) amplitude in multiple degrees of freedom at each joint. Injection parameters were determined using the clinician’s interpretation of which muscles would contribute to the upper limb tremor biomechanics analyzed kinematically.
Kinematic measures of tremor amplitude allowed detailed segmentation of tremor into directional components at each arm joint permitting a statistically significant decrease in mean UPDRS item 20 (rest tremor) at week 16 (p=0.006) and at week 32 (p=0.014), and in FTM tremor severity scores at week 6 (p=0.024). Ten participants perceived mild muscle weakness following the third treatment, which did not interfere with performing activities of daily living.
Kinematics is a simple method for standardizing assessments and treatment of upper limb Parkinson’s disease tremor, thereby personalizing tremor therapy and optimizing the effect of BoNT-A injections for Parkinson’s disease tremor.
Url:
DOI: 10.7916/D8BP0270
PubMed: 26566459
PubMed Central: 4636031
Affiliations:
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Bonab</wicri:regionArea><wicri:noRegion>Bonab</wicri:noRegion></affiliation></author><author><name sortKey="Samotus, Olivia" sort="Samotus, Olivia" uniqKey="Samotus O" first="Olivia" last="Samotus">Olivia Samotus</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Jack" sort="Lee, Jack" uniqKey="Lee J" first="Jack" last="Lee">Jack Lee</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Jog, Mandar" sort="Jog, Mandar" uniqKey="Jog M" first="Mandar" last="Jog">Mandar Jog</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Neurological Sciences, London Health Sciences Centre, Lawson Health Research Institute, London, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author></analytic><series><title level="j">Tremor and Other Hyperkinetic Movements</title><idno type="eISSN">2160-8288</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Focal treatment of Parkinson’s disease tremor by botulinum toxin type A incobotulinumtoxinA (BoNT-A) injections has been inadequately investigated and at best provides modest relief with significant muscle weakness. Complexity of multi-joint tremulous movements results in non-individualized dosing regimens. This 38-week open-label study used kinematic technology to guide muscle selection and improve efficacy of incobotulinumtoxinA (BoNT-A) injections for Parkinson’s disease tremor.</p></sec><sec><title>Methods</title><p>Participants (n=28) attended study visits at weeks 0, 6, 16, 22, 32, and 38, and were injected with BoNT-A at weeks 0, 16, and 32. During each visit, clinical tremor scales, the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Fahn–Tolosa–Marin (FTM), and kinematic assessments were conducted. Participants performed rest and postural scripted tasks with motion sensors placed over the wrist, elbow, and shoulder joints where tremor was quantified by angular root mean square (RMS) amplitude in multiple degrees of freedom at each joint. Injection parameters were determined using the clinician’s interpretation of which muscles would contribute to the upper limb tremor biomechanics analyzed kinematically.</p></sec><sec><title>Results</title><p>Kinematic measures of tremor amplitude allowed detailed segmentation of tremor into directional components at each arm joint permitting a statistically significant decrease in mean UPDRS item 20 (rest tremor) at week 16 (p=0.006) and at week 32 (p=0.014), and in FTM tremor severity scores at week 6 (p=0.024). Ten participants perceived mild muscle weakness following the third treatment, which did not interfere with performing activities of daily living.</p></sec><sec><title>Discussion</title><p>Kinematics is a simple method for standardizing assessments and treatment of upper limb Parkinson’s disease tremor, thereby personalizing tremor therapy and optimizing the effect of BoNT-A injections for Parkinson’s disease tremor.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Jankovic, J" uniqKey="Jankovic J">J Jankovic</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Milanov, I" uniqKey="Milanov I">I Milanov</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kraus, Ph" uniqKey="Kraus P">PH Kraus</name></author><author><name sortKey="Lemke, Mr" uniqKey="Lemke M">MR Lemke</name></author><author><name sortKey="Reichmann, H" uniqKey="Reichmann H">H 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Pietraszek</name></author><author><name sortKey="Labuz Roszak, B" uniqKey="Labuz Roszak B">B Labuz-Roszak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rahimi, F" uniqKey="Rahimi F">F Rahimi</name></author><author><name sortKey="Bee, C" uniqKey="Bee C">C Bee</name></author><author><name sortKey="South, A" uniqKey="South A">A South</name></author><author><name sortKey="Debicki, D" uniqKey="Debicki D">D Debicki</name></author><author><name sortKey="Jog, M" uniqKey="Jog M">M Jog</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Walt, A" uniqKey="Van Der Walt A">A Van Der Walt</name></author><author><name sortKey="Sung, S" uniqKey="Sung S">S Sung</name></author><author><name sortKey="Spelman, T" uniqKey="Spelman T">T Spelman</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Iran</li></country></list><tree><country name="Iran"><noRegion><name sortKey="Rahimi, Fariborz" sort="Rahimi, Fariborz" uniqKey="Rahimi F" first="Fariborz" last="Rahimi">Fariborz Rahimi</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Samotus, Olivia" sort="Samotus, Olivia" uniqKey="Samotus O" first="Olivia" last="Samotus">Olivia Samotus</name></noRegion><name sortKey="Jog, Mandar" sort="Jog, Mandar" uniqKey="Jog M" first="Mandar" last="Jog">Mandar Jog</name><name sortKey="Jog, Mandar" sort="Jog, Mandar" uniqKey="Jog M" first="Mandar" last="Jog">Mandar Jog</name><name sortKey="Lee, Jack" sort="Lee, Jack" uniqKey="Lee J" first="Jack" last="Lee">Jack Lee</name><name sortKey="Samotus, Olivia" sort="Samotus, Olivia" uniqKey="Samotus O" first="Olivia" last="Samotus">Olivia Samotus</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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