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Title: OnabotulinumtoxinA treatment for MS-tremor modifies fMRI tremor response in central sensory-motor integration areas
Authors: Boonstra, Frederique
Evans, Andrew
Noffs, Gustavo
Perera, Thushara
Jokubaitis, Vilija
Stankovich, Jim
Vogel, Adam
Moffat, Bradford
Butzkueven, Helmut
Kolbe, Scott
van der Walt, Anneke
Keywords: Tremor
OnabotulinumtoxinA
fMRI
Neural plasticity
Issue Date: Feb-2020
Publisher: Elsevier B.V.
Citation: Boonstra, F. M. C., A. Evans, G. Noffs, T. Perera, V. Jokubaitis, J. Stankovich, A. P. Vogel, B. A. Moffat, H. Butzkueven, S. C. Kolbe, and A. van der Walt. 2020. OnabotulinumtoxinA treatment for MS-tremor modifies fMRI tremor response in central sensory-motor integration areas. Multiple sclerosis and related disorders. 40: 101984.
Abstract: Background: Treatment of tremor in MS is an unmet need. OnabotulinumtoxinA (BoNT-A) has shown promising results; however, little is known regarding its effects on the brain. The clinical presentation of tremor MS is shown to depend on subcortical neural damage and cortical neural plasticity. This study aimed to identify effects of onabotulinumtoxinA (BoNT-A) on brain activation in MS and upper-limb tremor using functional MRI. Methods: Forty-three MS participants with tremor were randomized to receive intramuscular injections of placebo (n = 22) or BoNT-A (n = 21). Tremor was quantified using the Bain score (0–10) for severity, handwriting and Archimedes drawing at baseline, 6 weeks and 12 weeks. Functional MRI activation within two previously identified clusters, ipsilateral inferior parietal cortex (IPL) and remotor/supplementary motor cortex (SMC) of compensatory activity, was measured at baseline and 6 weeks. Results: Treatment with BoNT-A resulted in improved handwriting tremor at 6 weeks (p = 0.049) and 12 weeks (p= 0.014), and tremor severity -0.79 (p=0.007) at 12 weeks. Furthermore, the patients that received BoNT-A showed a reduction in activation within the IPL (p = 0.034), but not in the SMC. The change in IPL activation correlated with the reduction in tremor severity from baseline to 12 weeks (β = 0.608; p = 0.015) in the BoNTA group. No tremor and fMRI changes were seen in the placebo treated group. Conclusion: We have shown that reduction in MS-tremor severity after intramuscular injection with BoNT-A is associated with changes in brain activity in sensorimotor integration regions.
URI: http://repository.bionicsinstitute.org:8080/handle/123456789/387
ISSN: 2211-0348
Appears in Collections:Neurobionics Research Publications

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