Kinematic-based BoNT-A Bilateral Upper Limb PD Therapy
Kinematic-based BoNT-A Bilateral Upper Limb PD Therapy
The primary objective is to study the efficacy of botulinum toxin type A (BoNT-A) injected
 via kinematic parameters in the treatment of unilateral/bilateral upper extremity tremor in
 Parkinson's disease (PD) tremor. Kinematic assessment tools already developed in past
 clinical studies will be used in determining injection parameters. The objective is to study
 the composition of PD tremor using kinematic tools which may contribute to the knowledge of
 tremor complexity and contribute information that would benefit the development of injection
 parameters to improve efficacy and optimization of BoNT-A in tremor management. By injecting
 all bothersome tremulous upper limbs in Parkinson's disease patients, the investigators
 believe a greater improvement in Quality of Life on more daily tasks can be achieved compared
 to the investigator's earlier study in unilateral injections (REB#101749), which already
 showed significant improvement.
Inclusion Criteria:

 -  PD individuals diagnosed by UK Brain Bank Criteria with stage H&Y2-3 disease

 -  PD participants who are naïve to PD medications will be grouped into the "De novo" PD
 group

 -  PD participants stable on a low dose of Levodopa or on their PD medications for at
 least 3 months prior to their study enrolment will be grouped into the "L-dopa" PD
 group

 -  Participants who are botulinum toxin naïve for tremor management

 -  Patients will be screened for pregnancy by the physician

 -  Individuals with PD will be eligible for the study only if tremor is their primary and
 most bothersome symptom as determined by clinical exam and patient report denoting
 tremor-dominant phenotype

 -  Participants must be able to provide informed consent and to complete all study
 assessment scales and tasks.

 Exclusion Criteria:

 -  History of stroke

 -  History of ALS or Myasthenia Gravis

 -  History of COPD or emphysema

 -  Underlying arm muscle weakness or any related compartmental muscle syndrome

 -  Offending medications (Lithium, valproate, steroids, amiodarone, beta-adrenergic
 agonists (e.g. salbutamol).

 -  Persons prescribed zonisamide

 -  History of allergic or side effect reaction to botulinum toxin

 -  Contraindications per the BoNT-A drug monograph

 -  Women reporting that they are pregnant