{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T20:59:30Z","timestamp":1782421170167,"version":"3.54.5"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013116","name":"Merz Pharmaceuticals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013116","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Ontario Centre of Excellence"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Inadequate efficacy and significant side effect profile makes pharmacological treatment of Parkinson\u2019s disease (PD) tremor challenging. Personalized dosing of botulinum toxin type A (BoNT-A) using tremor analysis has shown efficacy and safety for treating upper limb tremor. This study incorporated a novel, standardized treatment algorithm for determining injection pattern and BoNT-A dosing, customizable by the physician, in PD patients with disabling tremor in one or both arms. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> This open-label study included 47 PD participants (25 \u201cDe-novo\u201d and 22 \u201cL-dopa\u201d) who received 4 serial BoNT-A treatments with follow-ups at 6 weeks post-treatment over 42 weeks. The treatment algorithm utilized kinematic tremor analysis of each participant\u2019s whole arm tremor and determined the physician\u2019s injection pattern of BoNT-A. Endpoints included changes in angular tremor amplitude, Fahn-Tolosa-Marin (FTM C) tremor scale, Movement Disorder Society-Unified Parkinson\u2019s disease rating scale (MDS-UPDRS) tremor-related score, tremor-related quality of life questionnaire, Likert ratings of perceived weakness, and maximal grip strength. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> BoNT-A significantly ( p\u2009&lt;\u20090.05) improved tremor amplitude (41.6%), quality of life (23.0%), UPDRS tremor score (29.6%), and arm function (FTM C; 24.6%) for both treatment cohorts from weeks 6 to 42. Maximum grip strength was reduced between 7.4% and 23.0% at follow-up visits and did not impact activities of daily living. Efficacy was obtained with first injection and remained without adjustment over two serial injection in 45% of participants. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> This is the first study to use a fully standardized treatment algorithm for personalization of BoNT-A injection patterns for disabling PD tremor over serial treatments. A sustained alleviation of tremor severity and improved arm function and quality of life fulfills an important unmet need for the treatment of PD tremor. This study demonstrated that BoNT-A can be administered as a monotherapy in tremor-dominant PD or as an add-on therapy for refractory PD tremor. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1756286420954083","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T09:11:30Z","timestamp":1600852290000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9275-6328","authenticated-orcid":false,"given":"Olivia","family":"Samotus","sequence":"first","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre \u2013 Lawson Health Research Institute, London, ON, Canada"},{"name":"Schulich School of Medicine and Dentistry, University of Western, London, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre \u2013 Lawson Health Research Institute, London, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7513-8651","authenticated-orcid":false,"given":"Mandar","family":"Jog","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre \u2013 Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada"},{"name":"Schulich School of Medicine and Dentistry, University of Western, 1151 Richmond Street, London, ON N6A 3K7, 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