7d44e9a52692241d3ad19155aff12f96 pmc_9961630.pdf 7586db925dfd75df3de4309f5d1a78a226fb0323 pmc_9961630.pdf 0c86995849119f78eb208d12ce92571fc25d798e8cd5cd59f2340ed7fe3253f3 pmc_9961630.pdf Title: Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study Subject: 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. Keywords: dystonia; tremor; dystonic tremor; botulinum toxin; deep brain stimulation Author: Belén González-Herrero, Ilaria Antonella Di Vico, Erlick Pereira, Mark Edwards and Francesca Morgante Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Feb 21 10:13:01 2023 CET ModDate: Tue Feb 21 10:15:16 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1300077 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GMZEJB+VnURWPalladioL Type 1 Custom yes yes no 10 0 TGJUYR+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 YENTGY+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 VZWQBV+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 VDNGGL+CMSY10 Type 1 Builtin yes yes no 28 0 GIFXFT+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes no 78 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 90 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 94 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 98 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 113 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 117 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 121 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 139 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 143 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 147 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 151 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-12 02:30:14 CEST RepresentationInformation: pmc_9961630.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-02 02:17:21 CET Size: 1300077 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 254 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Children: Item: Title: Treatment with Oral Medication Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Treatment with BoNT Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Treatment with Functional Neurosurgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Clinical Global Improvement (CGI-I) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Info: Title: Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study Author: Belén González-Herrero, Ilaria Antonella Di Vico, Erlick Pereira, Mark Edwards and Francesca Morgante Subject: 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. 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