THE QUESTION The tremors that affect many people with multiple sclerosis often prove resistant to treatment. Might Botox injections, which have been shown to stop various types of muscle spasms, ease this uncontrollable shaking as well?
THIS STUDY involved 23 adults with MS who experienced disabling tremors in their arms or hands. Each participant was injected with Botox (botulinum toxin type A) or a saline solution; three months later, they were injected with the opposite substance. No other medications were taken to control the shaking. Periodically, the participants were given standardized handwriting and drawing tests, and video recordings were made of their movements. When given Botox, the severity of their tremors generally declined, improving an average of two points on a 10-point scale and going from moderate to mild, compared with no change after a saline injection. Writing and drawing skills also improved with Botox, as did participants’ ability to do such things as pour water and drink from a cup. Mild muscle weakness developed more often after a Botox than a saline injection (42 percent of the time vs. 6 percent), but it went away within two weeks.
WHO MAY BE AFFECTED? People with MS who experience tremors , a common but not universal symptom of the disease. Although the shaking often occurs in the upper limbs, it can affect other parts of the body as well and can make walking or talking difficult. MS tremors are considered one of the most difficult symptoms to treat. A range of drugs have been tried — including antihistamines, beta blockers, anti-convulsives, anti-anxiety medications and marijuana — as have the use of weights and the administration of deep-brain stimulation, but all have yielded mixed results.
CAVEATS The study involved a small number of participants and assessed effects only on hand and arm tremors. Botox used in the study was provided by Allergan.
FIND THIS STUDY July 3 issue of Neurology (www.neurology.org).
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.