Botox May Ease Tremors in Multiple Sclerosis Patients

MONDAY, July 2 (HealthDay News) — The drug Botox, best known for
paralyzing muscles in the forehead to reduce wrinkles, can also relieve
shaking in the limbs of patients with multiple sclerosis, a small new
study suggests.

The treatment, which requires several times the amount of Botox
(botulinum toxin type A) used for wrinkles, could be expensive and it’s
not yet approved by the U.S. Food and Drug Administration for this use.
However, multiple sclerosis (MS) patients can still legally get the
treatment in the United States.

“Most patients tolerate the injections very well and are keen to
continue the treatment once they see the benefits they get from it,” said
Dr. Anneke van der Walt, lead study author and a neurologist and research
fellow at the Royal Melbourne Hospital, in Australia.

The shaking, known as a tremor, can affect one or both arms, or less
commonly the legs, in MS patients. “The shaking affects them when they’re
just trying to hold the arms up or do common daily tasks such as eating
and drinking, shaving and, particularly, writing,” van der Walt said. “As
with many MS symptoms, the tremor can be worse on very hot days and worse
when the person is tired.”

Physicians may turn to medications to treat the tremors, but the drugs
often have little effect, van der Walt said. Brain surgery to implant
electrodes is another option to relieve the tremors, but the benefits may
not last long.

In the new study, researchers randomly gave Botox or an inactive
placebo by injection to 23 MS patients with tremors in their arms. Twelve
weeks later, they reversed the injections so each arm ultimately received
both Botox and placebo.

The investigators assessed tremor severity and a variety of motor
skills before and after treatment.

According to the study, published in the July 3 issue of the journal
Neurology, after Botox injection, the patients had “significant”
improvement in tremors as well as in drawing and writing ability, as rated
on a 10-point scale.

One side effect, weakness in the limb, was very common in the patients
who received Botox — 42 percent reported it, compared with 6 percent
among those who received the placebo. However, the weakness was mild to
moderate in the patients and went away within two weeks.

It’s not clear how the drug relieves tremors, but it may have something
to do with changing the way muscles, nerves and the brain interact, van
der Walt said.

The patients received an average of 83 international units of Botox,
about three to four times the amount used for wrinkles, although less than
the typical amount that migraine patients get. The injections are needed
from two to four times a year and cost the equivalent of about $500 to
$1,000 in Australia, van der Walt said.

She recommended that “patients who are interested in exploring Botox
treatment for their tremor [should] make sure that they are referred to a
movement disorder specialist with both an interest in tremor and expertise
in complex Botox injections.”

Commenting on the study, Dr. Thomas Guttuso Jr., an assistant professor
of neurology at the University at Buffalo in New York, said Botox
currently is usually reserved for patients with severe, continuing tremor
“that is markedly interfering with certain activities of daily
living.”

Guttuso added, “My own experience with these patients is that Botox can
be effective when the tremor occurs more at the shoulders and elbows but
not as effective when the tremor occurs more at the wrists and fingers.”

He added that it’s not clear if Botox leads to “meaningful” differences
in the lives of patients, and future research will need to examine that
issue.

More information

For more about multiple sclerosis, visit the U.S. National Library of
Medicine.

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