PMID- 33047784
OWN - NLM
STAT- MEDLINE
DCOM- 20210107
LR  - 20220531
IS  - 0028-3843 (Print)
IS  - 0028-3843 (Linking)
VI  - 54
IP  - 6
DP  - 2020
TI  - Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled 
      trials.
PG  - 561-567
LID - 10.5603/PJNNS.a2020.0079 [doi]
AB  - BACKGROUND: Tremor is one of the most common movement disorders. It does not 
      usually respond to first-line drug treatments (e.g. propranolol, primidone, 
      anticholinergics, gabapentin and clonazepam) due to side effects and frequent 
      dose limitations. Botulinum toxin type A (BoNT-A) has been widely used to treat 
      tremor, but its efficacy and safety are uncertain. AIMS: To evaluate the efficacy 
      and safety of BoNT-A in the treatment of hand tremor. METHODS: We searched the 
      MEDLINE, EMBASE, PsycINFO and Cochrane Library databases for relevant randomised 
      controlled trials of the effects of BoNT-A injections on tremors, up to 20 
      February 2020. A meta-analysis of comparative effects was performed using R 
      studio software, and publication bias was examined using Egger's test. RESULTS: 
      Six studies examining a total of 245 participants with tremor were included in 
      the meta-analysis. The primary outcome of meta-analysis showed no difference in 
      clinical tremor scale scores between the BoNT-A group versus the placebo group 
      (standardised mean difference (SMD): -0.42, 95% confidence interval (CI): -1.94 
      to 1.10; I2 = 96%). For clinical tremor scale scores, subgroup analyses suggested 
      that the BoNT-A group may differ in terms of multiple sclerosis (MS) related 
      tremor (SMD: -1.10; 95% CI: -2.17 to -0.04; I2 = 79%) compared to a placebo, but 
      the difference did not exist in the outcome of essential tremor (ET) or hand 
      tremor (MD: -1.31; 95% CI: -3.39; 1.31; I2 = 97%). Grip strength (MD: -1.25, 95% 
      CI: -5.99 to 3.50, I2 = 97%) was slightly lower in the BoNT-A group, but the 
      difference was not significant. The incidence of adverse events (AEs), including 
      hand weakness (RR: 2.96, 95% CI: 1.40 to 6.24, I2 = 37%), was significantly 
      greater in the BoNT-A group than in the placebo group. Two studies were assessed 
      as having an overall low risk of bias. CONCLUSIONS: Our study confirms that 
      BoNT-A injections are unlikely to have an impact on patients with hand tremors. 
      However, subgroup analysis suggested that BoNT-A injections could have possible 
      benefits in MS-related tremor. While moderate to severe hand weakness AEs often 
      limits their use in clinical practice, additional well-designed double-blind, 
      placebo-controlled trials are needed to provide more robust conclusions.
FAU - Zheng, Xiaoyan
AU  - Zheng X
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China. zhengxiaoyan181@126.com.
FAU - Wei, Wenjing
AU  - Wei W
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China.
FAU - Liu, Peidong
AU  - Liu P
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China.
FAU - Wu, Chunxiao
AU  - Wu C
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China.
FAU - Lu, Liming
AU  - Lu L
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China.
FAU - Tang, Chunzhi
AU  - Tang C
AD  - Guangzhou University of Traditonal Chinese Medicine, No 12，Baiyun District, 
      510000 Guangzhou, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201013
PL  - Poland
TA  - Neurol Neurochir Pol
JT  - Neurologia i neurochirurgia polska
JID - 0101265
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
SB  - IM
MH  - *Botulinum Toxins, Type A/therapeutic use
MH  - Hand/innervation
MH  - Humans
MH  - Muscle Weakness
MH  - *Tremor/drug therapy
OTO - NOTNLM
OT  - botulinum toxin
OT  - meta-analysis
OT  - systematic review
OT  - tremor
EDAT- 2020/10/14 06:00
MHDA- 2021/01/08 06:00
CRDT- 2020/10/13 09:20
PHST- 2020/04/30 00:00 [received]
PHST- 2020/09/03 00:00 [accepted]
PHST- 2020/07/30 00:00 [revised]
PHST- 2020/10/14 06:00 [pubmed]
PHST- 2021/01/08 06:00 [medline]
PHST- 2020/10/13 09:20 [entrez]
AID - VM/OJS/J/68752 [pii]
AID - 10.5603/PJNNS.a2020.0079 [doi]
PST - ppublish
SO  - Neurol Neurochir Pol. 2020;54(6):561-567. doi: 10.5603/PJNNS.a2020.0079. Epub 
      2020 Oct 13.