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Ahead of print
Research paper
Published online: 2020-10-12
Submitted: 2020-04-30
Accepted: 2020-09-03
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Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled trials

Xiaoyan Zheng, Wenjing Wei, Peidong Liu, Chunxiao Wu, Liming Lu, Chunzhi Tang
DOI: 10.5603/PJNNS.a2020.0079
·
Pubmed: 33047784

open access

Ahead of print
Research paper
Published online: 2020-10-12
Submitted: 2020-04-30
Accepted: 2020-09-03

Abstract

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.

Abstract

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.

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Keywords

systematic review, meta-analysis, botulinum toxin, tremor

Supplementary Files (7)
PRISMA-P.docx
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Supplementary Figure S1: Article selection process.docx
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Supplementary figure S2: Forest plot of BoNT-A on Kinetic tremor severity in meta-analysis
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Supplementary figure S3: Forest plot of BoNT-A on Postural tremor severity in meta-analysis
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Supplementary Table S1
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Supplementary Table S2
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Supplementary S1: Search strategy
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About this article
Title

Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled trials

Journal

Neurologia i Neurochirurgia Polska

Issue

Ahead of print

Published online

2020-10-12

DOI

10.5603/PJNNS.a2020.0079

Pubmed

33047784

Keywords

systematic review
meta-analysis
botulinum toxin
tremor

Authors

Xiaoyan Zheng
Wenjing Wei
Peidong Liu
Chunxiao Wu
Liming Lu
Chunzhi Tang

References (24)
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