{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:27:00Z","timestamp":1791606420843,"version":"4.3.4"},"reference-count":17,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T00:00:00Z","timestamp":1550534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004489","name":"Mitacs","doi-asserted-by":"publisher","award":["IT03924"],"award-info":[{"award-number":["IT03924"]}],"id":[{"id":"10.13039\/501100004489","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013116","name":"Merz Pharma","doi-asserted-by":"publisher","award":["R.14.022"],"award-info":[{"award-number":["R.14.022"]}],"id":[{"id":"10.13039\/501100013116","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Variability of multi-joint essential tremor (ET) between patients and within the two upper limbs makes a visual assessment for the determination of botulinum toxin type A (BoNT-A) injections challenging. Kinematic tremor analysis guidance has succeeded in overcoming this challenge by making effective long-term unilateral BoNT-A injections for disabling ET. In this open-label study, 31 ET participants received three bilateral arm BoNT-A injection cycles over 30 weeks with follow-ups six-weeks post-treatment. Whole-arm kinematic assessment of tremor using a customized, automated algorithm provided muscle selection and dosing per muscle without clinician\u2019s assessment. Efficacy endpoints included Fahn-Tolosa-Marin tremor scale, quality of life (QoL) questionnaire, and maximum grip strength. BoNT-A reduced tremor amplitude by 47.7% in both the arms at week-6 (p &lt; 0.005) that persisted from weeks 18\u201330. QoL was improved by 26.5% (p &lt; 0.005) over the treatment period. Functional interference due to tremor was reduced by 30% (p &lt; 0.005) from weeks 6\u201330. Maximum grip strength was reduced at week 6 (p = 0.001) but was not functionally impaired for the participants. Effective bilateral ET therapy by personalized BoNT-A injections could be achieved using computer-assisted tremor analysis. By removing variability inherent within the clinical assessments, this standardized tremor analysis method enabled patients to have improved bimanual upper limb functionality after the first treatment.<\/jats:p>","DOI":"10.3390\/toxins11020125","type":"journal-article","created":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T03:05:52Z","timestamp":1550631952000},"page":"125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics"],"prefix":"10.3390","volume":"11","author":[{"given":"Olivia","family":"Samotus","sequence":"first","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre\u2014Lawson 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, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre\u2014Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandar","family":"Jog","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences, London Health Sciences Centre\u2014Lawson 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, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1002\/mds.26383","article-title":"Therapeutic advances in tremor","volume":"30","author":"Fasano","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"331","DOI":"10.5334\/tohm.239","article-title":"Defining the Treatment Gap: What Essential Tremor Patients Want That They Are Not Getting","volume":"5","author":"Louis","year":"2015","journal-title":"Tremor Other Hyperkinet Mov."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Samotus, O., Rahimi, F., Lee, J., and Jog, M. (2016). Functional Ability Improved in Essential Tremor by IncobotulinumtoxinA Injections Using Kinematically Determined Biomechanical Patterns\u2014A New Future. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153739"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Samotus, O., Lee, J., and Jog, M. (2017). Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178670"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Samotus, O., Lee, J., and Jog, M. (2018). Transitioning from Unilateral to Bilateral Upper Limb Tremor Therapy for Parkinson\u2019s Disease and Essential Tremor Using Botulinum Toxin: Case Series. Toxins, 10.","DOI":"10.3390\/toxins10100394"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.parkreldis.2018.06.019","article-title":"Botulinum toxin in essential hand tremor\u2014A randomized double-blind placebo-controlled study with customized injection approach","volume":"56","author":"Mittal","year":"2018","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Niemann, N., and Jankovic, J. (2018). Botulinum toxin for the treatment of hand tremor. 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Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1197\/j.jht.2005.02.009","article-title":"Measurement of Health Outcomes Following Tendon and Nerve Repair","volume":"18","author":"MacDermid","year":"2005","journal-title":"J. Hand. Ther."},{"key":"ref_17","unstructured":"Cutter, N.C., and Kevorkian, C.G. (1999). Handbook of Manual Muscle Testing, McGraw-Hill Health Professions Division. [1st ed.]."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/2\/125\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:33:13Z","timestamp":1760185993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/2\/125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,19]]},"references-count":17,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["toxins11020125"],"URL":"https:\/\/doi.org\/10.3390\/toxins11020125","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,19]]}}}