Comparison of the Effect of Botulinum Toxin Injection Under Ultrasound Guidance and Oral Propranolol in the Treatment of Moderate to Severe Essential Hand Tremor

Abstract

Background: Tremor is one of the most common movement disorders affecting the upper limb (proximal and distal), neck, or vocal cords. Primidone and propranolol are the most effective oral medications prescribed for essential tremors. 12 to 66% of those treated with propranolol have complications, and 30% of patients do not respond to oral medications. Methods: In this study, a clinical trial was conducted to compare the effect of botulinum toxin Injection and Oral Propranolol in the Treatment of essential hand Tremor on patients referred to Golestan Hospital's neurology clinic complaining of hand tremor in 2016 and 2017. Eighty essential tremor patients were assigned to the study and divided into two groups, the botulinum toxin group had muscular injection under ultrasound guidance, and the propranolol group received oral propranolol. Patients were evaluated at one-month intervals, weeks 0, 4, 8, and 12. The severity of the tremor was assessed using the TETRAS clinical scale. Another patient evaluation was the RAND SF-36 Quality of Life Questionnaire, which was presented to patients at weeks 0 and 8. Results: Our findings in this study revealed that the intramuscular injection of botulinum toxin is more effective in treating moderate-to-severe Essential Tremor hand than the intake of oral propranolol. Conclusion: Botulinum toxin is recommended for moderate-to-severe cases of essential hand Tremor, especially for patients who fail to bear the treatment course or take several medications that prompt striking drug interference.

Keywords

• essential tremor
• botulinum toxin
• propranolol
• ultrasound