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April 25, 2010

NYT: Can botox stop essential tremor (hand, face, etc)?

On April 22, 2010, the New York Times published a short story entitled "Can Botox Stop the Hands From Shaking?"

The story goes on to report that "Intramuscular injections of Botox, or botulinum toxin, may play a limited role in the treatment of wrist and voice tremors in patients with essential tremor."

Indeed, I do agree with the "limited" role botox has on essential tremor (emphasis on limited) whether the tremor involves the hand or head/neck region which is what I deal with more often.

Botox works GREAT when only 1 or 2 muscles are involved such as muscular dystonias where discrete muscles are afflicted such as torticollis (sternocleidomastoid muscle and/or trapezius muscles) and spasmodic dysphonia (thyroarytenoid muscle).

Unfortunately, in most cases of tremor (not dystonia), multiple different muscles are involved and it is very difficult to pinpoint and inject every single muscle that is suffering from tremor. A patient can end up with over a dozen injections to hit each affected muscle, and still not get a perfect outcome due to overall weakness from having so many injections.

Let's take vocal tremor... Vocal tremor often has both a laryngeal, oral, as well as neck component (patient's head often shakes while talking). As such, if one theoretically wanted to inject botox for vocal tremor, all these muscles may potentially need to be injected:

• thyroartenoid
• thyrohyoid
• sternothyroid
• infrahyoid
• omohyoid
• sternohyoid
• posterior cricoarytenoid
• lateral cricoarytenoid
• sternocleidomastoid
• superior pharyngeal constrictor
• middle pharyngeal constrictor
• inferior pharyngeal constrictor
• genioglossus
• hyoglossus
• styloglossus
• plalatoglossus
• levator veli palatini
• tensor veli palatini
• palatoglossus
• palatopharyngeus
• platysma
• etc.

That's a lot of muscles... which means a lot of injections... which means overall increased risk of overall weakness... AND the tremor may still be present.

However, botox injections may STILL be helpful to reduce symptoms of vocal tremor, but complete elimination of vocal tremor may be not be possible to achieve. Read more...

As many people already know, botox works great for wrinkles because discrete muscles are involved (just like for dystonia).

Our office provides botox injections for wrinkles, torticollis, spasmodic dysphonia, etc... but not for tremor UNLESS it is involving only a few muscles (very rare!).

Read the NYT article here.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

1 comment:

  1. My essential tremor is a rotational motion of the lower arm. Are there a lot of muscles involved in that motion?


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