Propranolol and Botulinum Toxin for Essential Vocal Tremor
Condition: Essential Vocal Tremor; Essential Voice Tremor; Essential Tremor; Voice Tremor; Vocal Tremor
MeSH terms: Tremor; Essential Tremor
Intervention: Propranolol; Botulinum Toxin
Intervention description: After a discussion of the risks and benefits of propranolol therapy, the patient will then be given a prescription by the principal investigator for propranolol. This prescription will consist of a starting dose of generic immediate-release at 10 mg three times daily (30 mg each day) with an increase in dose in 5-7 days if there is no effect (60 mg each day) and if the patient had demonstrated no side effects. Dose may be increased to 240 mg each day depending on patient improvement and side effect profile.; At the second evaluation, patient will receive botulinum toxin injections. The risks and benefits of botulinum toxin therapy will be explained to the patient, and bilateral injections will take place.
Intervention MeSH terms: Propranolol; Botulinum Toxins
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 18.0
Sex: All
Minimum age: 45 Years
Healthy volunteers: No
Keywords: Essential Tremor; Essential Vocal Tremor; Essential Voice Tremor

Summary:

      Essential tremor is the most common adult-onset movement disorder, and essential voice tremor
      is the vocal manifestation of essential tremor. While nearly all essential tremor patients
      experience hand tremor, many also manifest head tremor and voice tremor. Essential voice
      tremor can lead to increased vocal effort, decreased intelligibility, and misconstrued
      emotional state. Only one medication, propranolol, is FDA-approved to treat essential tremor.
      Propranolol is not felt to be nearly as effective for axial tremors (head, trunk, neck) as it
      is for extremity tremors. However, this has not been studied with any objective assessment in
      a prospective way for EVT. For patients with essential voice tremor, the limited published
      data suggests that botulinum toxin has been shown to lead to functional voice improvement.
      Botulinum toxin, though also not well-studied with objective voice outcomes, is a commonly
      used clinical therapy for treatment of essential voice tremor. While it is used more often
      for essential voice tremor than propranolol therapy, botulinum toxin also has not been
      prospectively studied with validated, objective voice outcome measures. The investigators
      would like to determine if propranolol has any significant effect on vocal tremor. The
      investigators would also like to determine, in an objective way, the effect of botulinum
      toxin on vocal tremor. If effective, propranolol would provide an affordable and non-invasive
      alternative or addition to botulinum toxin injections for patients with essential voice
      tremor.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Diagnosis of essential voice tremor

          -  Patients who have received or are planning to receive botulinum toxin injections for
             essential voice tremor

          -  Patients who give informed consent to be contacted for research

        Exclusion Criteria:

          -  Patients who are already on a beta blocker

          -  Patients who suffer from hypotension, bradycardia, or otherwise have a medical
             contraindication to beta blocker therapy (eg. moderate to severe bronchial asthma)

        If the patient has received botulinum toxin injections for EVT previously, a three-month
        washout period is necessary before participation.