Dr Stephen Duma BEng(Elect;Hons) MBiomedEng MBBS PhD FRACP

Botulinum toxin can be used to treat different types of tremor, including dystonic tremor, essential tremor and Parkinsonian tremor. Of utmost importance is examination, to determine the muscles involved in the tremor and this is a very specialised skill that Dr Duma now brings to East Neurology.

For example, a dystonic tremor of the arm may be characterised as wrist supination and pronation (back and forth movement of the wrist). In this case, to treat the tremor with botulinum toxin, the supinator and pronator muscles are targeted with EMG (needle muscle test), during which tremor muscle activity can often be heard, following which botulinum toxin is injected.

To avoid muscle weakness, small doses are used initially and can be increased at subsequent injection visits depending on previous response.

The aim of botulinum toxin is to provide an improvement in the intensity of the tremor but it needs to be repeated on average every 3 months, and so is not a cure.

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