Predicting Improvement in Writer’s Cramp Symptoms following Botulinum Neurotoxin Injection Therapy

Tremor and Other Hyperkinetic Movements

article

Mallory Jackman¹  Mehdi Delrobaei²  Fariborz Rahimi³  S. Farokh Atashzar⁴  Mahya Shahbazi⁴  Rajni Patel¹  Mandar Jog¹ 

[1] Lawson Health Research Institute;Faculty of Electrical Engineering, K. N. Toosi University of Technology;Department of Electrical and Computer Engineering, Bonab University;Department of Electrical and Computer Engineering, Western University;Department of Clinical Neurological Sciences, Western University

关键词: Writer’s cramp;    focal hand dystonia;    botulinum toxin;    kinematics;   

DOI  :  10.5334/tohm.286

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

Introduction: Writer’s cramp is a specific focal hand dystonia causing abnormal posturing and tremor in the upper limb. The most popular medical intervention, botulinum neurotoxin type A (BoNT-A) therapy, is variably effective for 50–70% of patients. BoNT-A non-responders undergo ineffective treatment and may experience significant side effects. Various assessments have been used to determine response prediction to BoNT-A, but not in the same population of patients. Methods: A comprehensive assessment was employed to measure various symptom aspects. Clinical scales, full upper-limb kinematic measures, self-report, and task performance measures were assessed for nine writer’s cramp patients at baseline. Patients received two BoNT-A injections then were classified as responders or non-responders based on a quantified self-report measure. Baseline scores were compared between groups, across all measures, to determine which scores predicted a positive BoNT-A response. Results: Five of nine patients were responders. No kinematic measures were predictably different between groups. Analyses revealed three features that predicted a favorable response and separated the two groups: higher than average cramp severity and cramp frequency, and below average cramp latency. Discussion: Non-kinematic measures appear to be superior in making such predictions. Specifically, measures of cramp severity, frequency, and latency during performance of a specific set of writing and drawing tasks were predictive factors. Since kinematic was not used to determine the injection pattern and the injections were visually guided, it may still be possible to use individual patient kinematics for better outcomes.

【 授权许可】

CC BY