The Efficacy of Botulinum Toxin in Disabling Multiple Sclerosis (MS) Tremor
The Efficacy of Botulinum Toxin in Disabling Multiple Sclerosis (MS) Tremor
The incidence of tremor in Multiple Sclerosis (MS) has been estimated to affect up to 2/3rds
 of patients. Over half of the tremors involve the upper limb and frequently lead to further
 disability. Medical treatment of MS tremor is generally unrewarding, although carbamazepine,
 clonazepam, glutethimide, hyoscine, isoniazid, ondansetron, primidone, and
 tetrahydrocannabinol have been reported to have some beneficial effect but published evidence
 of effectiveness is very limited. The investigators' experience to date suggests that many of
 the upper limb tremors may potentially be responsive to Botulinum toxin injection therapy.

 Aims:

 1. The investigators aim to determine the efficacy of commonly used doses of BOTOX on the
 patients with symptomatic unilateral or bilateral arm tremor due to MS; and any side effects
 associated with this treatment.
Inclusion Criteria:

 -  Relapsing-remitting MS or secondary progressive MS according to the Mc Donald criteria

 -  Age 18-80 years of age

 -  Competent to understand and sign informed consent

 -  Presence of symptomatic head and/or limb tremor

 Exclusion Criteria:

 -  Treatment with botulinum toxin type A of any brand within the 4 months prior to
 enrollment

 -  A known contraindication to Botox injection

 -  Pregnancy