{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T23:00:42Z","timestamp":1771455642891,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Background: Botulinum toxin type A (BoNT-A) therapy for upper-limb tremor has emerged as a promising option. However, it is unclear in real-world practices whether a technology-guided approach can compare with expert clinical assessments (including surface anatomy and palpation) for improving outcomes. This retrospective study aims to review our clinical outcomes of treating essential tremor (ET) and Parkinson\u2019s disease (PD) tremor using either clinical- or kinematic-based injection pattern determination methods. Methods: 68 ET and 45 PD patients received at least one injection for their upper-limb tremor (unilateral or bilateral) in the last 7 years. Demographics of patients and BoNT-A injections were collected. A Mann\u2013Whitney U statistical test was used to compare outcome measures between ET and PD cohorts. Results: Mean age (72 \u00b1 9 years), number of injections (5), years receiving therapy (~2 years), clinic- (~57%) or kinematic-based patterns, and self-paying (52%) were similar between both cohorts. BoNT-A as a monotherapy in both upper limbs was received in more ET than PD patients. Double reconstitution of Xeomin\u00ae in the wrist flexors\/extensors, supinator, biceps, and triceps were most injected. Discontinuation due to no benefit\/weakness was not dependent on the injection pattern determination approach. Conclusions: Kinematic-based BoNT-A injections produced similar treatment outcomes to injections based on the clinical expertise of the expert injector. This suggests that kinematics could be used by a non-expert to attain equivalent efficacy potentially improving access to this treatment.<\/jats:p>","DOI":"10.3390\/toxins14080557","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T22:53:30Z","timestamp":1660776810000},"page":"557","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Real-World Longitudinal Experience of Botulinum Toxin Therapy for Parkinson and Essential Tremor"],"prefix":"10.3390","volume":"14","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\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":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yekta","family":"Mahdi","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":[{"role":"author","vocabulary":"crossref"}]},{"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\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":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.parkreldis.2015.04.019","article-title":"Tremor-Related Quality of Life: A Comparison of Essential Tremor vs. Parkinson\u2019s Disease Patients","volume":"21","author":"Louis","year":"2015","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"628","DOI":"10.3389\/fneur.2018.00628","article-title":"Impact of Tremor on Patients with Early Stage Parkinson\u2019s Disease","volume":"3","author":"Heusinkveld","year":"2018","journal-title":"Front. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.parkreldis.2005.05.009","article-title":"Quality of life in Essential Tremor Questionnaire (QUEST): Development and initial validation","volume":"11","author":"Pahwa","year":"2005","journal-title":"Park. Relat. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1136\/postgradmedj-2019-136647","article-title":"Treatment of essential tremor: Current status","volume":"96","author":"Sharma","year":"2020","journal-title":"Postgrad. Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"120203","DOI":"10.1016\/j.jns.2022.120203","article-title":"Botulinum toxin for the treatment of tremor","volume":"435","author":"Mittal","year":"2022","journal-title":"J. Neurol. Sci."},{"key":"ref_6","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_7","first-page":"CD003735","article-title":"Anticholinergics for symptomatic management of Parkinson\u2019s disease","volume":"2","author":"Katzenschlager","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/WCO.0000000000000465","article-title":"New neurosurgical approaches for tremor and Parkinson\u2019s disease","volume":"30","author":"Fasano","year":"2017","journal-title":"Curr. Opin. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5334\/tohm.582","article-title":"Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor\u2014The Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment","volume":"10","author":"Mittal","year":"2020","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1016\/S0140-6736(21)00218-X","article-title":"Parkinson\u2019s disease","volume":"12","author":"Bloem","year":"2021","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Samotus, O., Lee, J., and Jog, M. (2019). Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics. Toxins, 11.","DOI":"10.3390\/toxins11020125"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1756286420954083","DOI":"10.1177\/1756286420954083","article-title":"Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis","volume":"13","author":"Samotus","year":"2020","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.mayocp.2017.06.010","article-title":"Botulinum Toxin in Parkinson Disease Tremor: A Randomized, Double-Blind, Placebo-Controlled Study with a Customized Injection Approach","volume":"92","author":"Mittal","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_15","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":"Park. Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zakin, E., and Simpson, D. (2017). Botulinum toxin in management of limb tremor. Toxins, 9.","DOI":"10.3390\/toxins9110365"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.parkreldis.2019.01.023","article-title":"Botulinum toxin for the treatment of tremor","volume":"63","author":"Mittal","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Samotus, O., Lee, J., and Jog, M. (2021). Developing a Consistent, Reproducible Botulinum Toxin Type A Dosing Method for Upper Limb Tremor by Kinematic Analysis. Toxins, 13.","DOI":"10.3390\/toxins13040264"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/mdc3.12832","article-title":"Treatment of Upper Limb Tremor with Botulinum Toxin: An Individualized Approach","volume":"6","author":"Kamel","year":"2019","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Niemann, N., and Jankovic, J. (2018). Botulinum Toxin for the Treatment of Hand Tremor. Toxins, 10.","DOI":"10.3390\/toxins10070299"},{"key":"ref_21","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, 6.","DOI":"10.1371\/journal.pone.0178670"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1055\/s-0035-1571217","article-title":"Botulinum toxin for the treatment of tremor and tics","volume":"36","author":"Lotia","year":"2016","journal-title":"Semin. Neurol."},{"key":"ref_23","first-page":"11","article-title":"Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics","volume":"45","author":"Samotus","year":"2017","journal-title":"CJNS"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"348","DOI":"10.5334\/tohm.240","article-title":"Effective Management of Upper Limb Parkinsonian Tremor by IncobotulinumtoxinA Injections Using Sensor-based Biomechanical Patterns","volume":"5","author":"Rahimi","year":"2015","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_25","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"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/8\/557\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:10:56Z","timestamp":1760141456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/8\/557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,17]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["toxins14080557"],"URL":"https:\/\/doi.org\/10.3390\/toxins14080557","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,17]]}}}