Medical Rounds with Dr. Duarte Machado

It’s the world’s most common adult movement disorder. ”Essential tremor” affects some 10-million people in the United States, more than 2-percent of the population. Dr. Duarte Machado, co-director of the David and Rhoda Chase Family Movement Disorders Center, explains.



Q. What are essential tremors?
A. Essential tremor is an extremely common movement disorder that most commonly presents as an action or postural tremor in the arm, hands, or head. Imaging studies suggest that essential tremor is correlated with neurodegeneration in a part of the brain called the cerebellum. Next month is National Essential Tremor Awareness Month, so it is hoped that more people will better understand this condition.

Q. How do you manage tremor disorders?
A. Current first-line medications include beta-blockers such as propranolol and anti-epileptics such as primidone. However, these medications are only partially effective at controlling tremors.

Q. Cab you describe a recently completed clinical trial using botulinum toxin for essential tremors?
A. In the event that oral medications fail to manage symptoms, botulinum toxin can be injected into the affected muscles. This study is the first double-blinded study to determine the efficacy of incobotulinumtoxinA (Xeomin) as a treatment for essential tremor using a customized injection strategy for each patient.

Q. What were the findings of this study?
A. The results have recently been submitted for publication. What I saw was a statistically significant number of patients (48%) experienced improvement of tremor after Xeomin injection as compared to placebo (14%) injection (p=0.043 by Fisher exact test). What’s more, patients tolerated this well without the level of side effect seen in earlier studies. This is now a treatment that my colleague, Dr. de Marcaida, and I are offering to any patient at the Hartford Healthcare Movement Disorders Center.


For more information

Visit: Hartford HealthCare Movement Disorders Center

Free class: Understanding Tremor Disorders, Feb. 28


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