Tremor and Other Hyperkinetic Movements最新文献

{"title":"Botulinum Neurotoxin Treatment of Camptocormia- A Critical Review and Update.","authors":"Ava G Tohidian, Ali Ghaseminejad-Bandpey, Bahman Jabbari","doi":"10.5334/tohm.1230","DOIUrl":"10.5334/tohm.1230","url":null,"abstract":"<p><p>Camptocormia is a disabling postural disorder characterized by involuntary forward flexion of the thoracolumbar spine that resolves in the supine position. It is mostly associated with Parkinson's disease and parkinsonian syndromes, but may also occur in dystonia, paraspinal myopathies, and after exposure to some drugs. Available treatments, including postural aids, medication adjustment, and deep brain stimulation, are often only partly effective and may carry risk. Because overactivity of trunk flexor muscles is thought to contribute to camptocormia, botulinum neurotoxin (BoNT) has emerged as a potential treatment. This review critically evaluates the published literature on BoNT treatment of camptocormia. We searched Medline, Google Scholar, and Scopus for English-language publications published through April 1, 2026, identifying nine reports including three case series and six single case reports. No randomized placebo-controlled trials were found. Most studies used onabotulinumtoxinA, but injection targets, dosing, and outcome measures varied. Improvement in posture, reduced pain and functional benefits were described. The most consistent benefit was with bilateral injection of the rectus abdominis and external oblique muscles, whereas isolated psoas or iliopsoas injections were less effective. Overall, BoNT appears promising for the treatment of camptocormia; however, randomized, placebo-controlled trials are needed to confirm efficacy and establish optimal treatment protocols. The studies should be conducted with caution because long-term outcome data are limited and reported efficacy has been modest.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"46"},"PeriodicalIF":1.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Diagnosed Essential Tremor Using Electronic Healthcare Records: A Population-Based Study in Northeast-Central Pennsylvania.","authors":"Daniel Kratovil, Seung Yeon Jung, Sonia Stoica, Matthew Roy, Alia C Stanciu, M Cosmin Sandulescu","doi":"10.5334/tohm.1229","DOIUrl":"10.5334/tohm.1229","url":null,"abstract":"<p><strong>Background: </strong>Essential tremor (ET) is one of the most common movement disorders, yet reported prevalence estimates vary widely, likely because of differences in ascertainment strategies, which can influence data validity and comparability. Electronic healthcare records (EHRs) offer an opportunity to estimate prevalence at the population level. However, the impact of these strategies remains incompletely understood, raising questions about the accuracy and generalizability of the resulting estimates.</p><p><strong>Methods: </strong>We conducted a retrospective, population-based cross-sectional study using EHR data from the Geisinger Health System (GHS) to identify cases of ET. Cases were mapped to a census-defined population of 1,081,934 individuals aged ≥10 years in Northeast-Central Pennsylvania on April 1, 2020. ET prevalence was assessed using two ascertainment strategies: (1) the neurology cohort and (2) the all-specialties cohort. Age-threshold, age-specific, and sex-stratified prevalence estimates were calculated, along with age-standardized rates based on the 2020 U.S. population.</p><p><strong>Results: </strong>Crude prevalence of ET was 0.261% (95% CI, 0.252-0.271) in the neurology cohort and 0.653% (95% CI, 0.638-0.668) in the all-specialties cohort. Age-standardized prevalence was 0.40% (95% CI, 0.39-0.41) and 1.01% (95% CI, 1.00-1.02), respectively. Prevalence increased progressively with age across both ascertainment strategies, and sex-stratified analyses demonstrated similar age-related patterns with a modest female predominance, particularly in the all-specialties cohort.</p><p><strong>Discussion: </strong>ET prevalence estimates vary substantially depending on ascertainment strategy, with broader EHR-based definitions identifying more than twice as many cases as neurologist-restricted approaches. These findings highlight the importance of standardization in improving comparability across studies.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"45"},"PeriodicalIF":1.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: A Case of Cala Trio-Induced Glossopharyngeal Neuralgia in a Patient with Essential Tremor and Idiopathic Parkinson's Disease.","authors":"Moriah R Arnold, Amie L Hiller","doi":"10.5334/tohm.1258","DOIUrl":"10.5334/tohm.1258","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.5334/tohm.1224.].</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"44"},"PeriodicalIF":1.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Hypoxic Myoclonus and Deep Brain Stimulation. Experience from a Small Patient Cohort and Literature Review Highlighting Variable Outcomes.","authors":"Tiziana De Santis, Alon Y Mogilner, Michael Pourfar","doi":"10.5334/tohm.1171","DOIUrl":"10.5334/tohm.1171","url":null,"abstract":"<p><p>Lance Adams Syndrome (LAS), or chronic post-hypoxic myoclonus (PHM), is a rare and disabling condition which occurs in the aftermath of a diffuse hypoxic brain injury, usually when patient regains consciousness. Due to its refractoriness to antiepileptics, deep brain stimulation (DBS) has been attempted over the past fifteen years. We describe three patients who underwent Globus Pallidus interna (GPi)-DBS at the NYU Langone Department of Neurosurgery. Despite varying stimulation parameters and contact combinations, none achieved substantial improvement of action and negative myoclonus or regained the ability to ambulate unassisted. We compared our results with previous reports. Our literature review identified ten cases of LAS treated with DBS since 2010. The target was GPi in 8/10 patients, the ventralis intermedius (VIM) nucleus in one, and the subtalamic nucleus (STN) in one. Varying degrees of improvement were reported, with some evidence suggesting that long pulse width and lower frequency might be more effective. However, most reports provided only partial Unified Myoclonus Rating Scale (UMRS) scores, with missing information on rest and reflex myoclonus as well as negative myoclonus. Due to the paucity of prior reports and the limited generalizability of existing evidence, the efficacy of DBS in LAS has yet to be demonstrated. Further case reports, both positive and negative, supported by neurophysiological measures, may help bridge this knowledge gap.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"43"},"PeriodicalIF":1.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pallidal Deep Brain Stimulation in Dystonia: Investigating Differential Response by Dystonia Distribution.","authors":"Sushuma Yarlagadda, Margi Patel, Sheila Rajagopalan, H A Jinnah, Stewart A Factor, Svjetlana Miocinovic, Laura M Scorr","doi":"10.5334/tohm.1175","DOIUrl":"10.5334/tohm.1175","url":null,"abstract":"<p><strong>Background: </strong>Dystonia is characterized by involuntary intermittent or sustained abnormal movements or postures. Deep brain stimulation (DBS) is an effective treatment, and response has been shown to vary across body regions but literature depicting this pattern is conflicting. Our study analyzes dystonia response to DBS by body distribution using the Burke-Fahn-Marsden Rating Scale motor (BFMRS-M) score and the Global Dystonia Rating Scale (GDRS).</p><p><strong>Methods: </strong>We reviewed standardized videos of patients with isolated non-acquired dystonia obtained at baseline and post-DBS of unilateral or bilateral globus pallidus interna between 2008 and 2020. BFMRS-M and GDRS were scored using blinded assessment by two movement disorders neurologists. Mean baseline and post-DBS scores were compared using a paired t-test.</p><p><strong>Results: </strong>Ten male and 10 female patients were included, with average age at surgery 49 years. Post-DBS total BFMRS-M scores demonstrated improvement (20.5 ± 3.6 vs 11.9 ± 2.6) and there was significant improvement in neck sub-scores (4.9 ± 0.6 vs 2.5 ± 0.4). All patients demonstrated an improved total GDRS score post-DBS (21.6 ± 3.7 vs 11.1 ± 2.1), with significant improvements in GDRS sub-scores of the neck (5.9 ± 0.6 vs 2.6 ± 0.4) and shoulder & proximal arms (4.7 ± 1.1 vs 1.6 ± 0.5).</p><p><strong>Discussion: </strong>Efficacy of DBS varies by distribution of dystonia and should be considered in treatment planning discussions. GDRS is a more sensitive outcome measurement for dystonia compared to BFMRS-M and should be more routinely integrated into studying treatment response.</p><p><strong>Highlights: </strong>This study shows that pallidal deep brain stimulation yields differential improvement across dystonia body regions, with greatest benefit in the neck and proximal arms. These results highlight that the Global Dystonia Rating Scale is more sensitive to regional outcomes compared to the commonly utilized Burke-Fahn-Marsden Rating Scale.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"42"},"PeriodicalIF":1.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Distributed Oscillatory Network Model of Parkinsonian Tremor: Integrating Basal Ganglia and Cerebello-Thalamic Circuits.","authors":"Victor Fellipe Bispo Macêdo, Alana Madeiro de Melo Barboza, Yasmin Lopes Silva Nogueira, Amanda Sena Cocivera Machado, Nilcele Freire de Oliveira","doi":"10.5334/tohm.1198","DOIUrl":"10.5334/tohm.1198","url":null,"abstract":"<p><strong>Background: </strong>Parkinsonian tremor remains one of the least understood motor manifestations of Parkinson's disease. Unlike bradykinesia and rigidity, tremor often shows weak correlation with dopaminergic degeneration and variable responses to pharmacological and surgical treatments, suggesting mechanisms beyond classical basal ganglia dysfunction. Increasing evidence indicates that tremor may arise from interactions between multiple motor circuits rather than from a single oscillatory generator.</p><p><strong>Methods: </strong>This mechanistic review integrates evidence from electrophysiological recordings, neuroimaging studies, lesion observations, and computational modeling studies investigating the neural mechanisms of parkinsonian tremor. Relevant literature addressing basal ganglia circuits, cerebello-thalamo-cortical pathways, and tremor-related neural oscillations was analyzed to develop a conceptual network framework.</p><p><strong>Results: </strong>Available evidence supports the involvement of a distributed oscillatory network in tremor generation. Within this framework, basal ganglia circuits, particularly the subthalamic nucleus-globus pallidus externa loop, act as primary oscillatory generators. Cerebello-thalamo-cortical pathways and brainstem nuclei modulate synchronization and amplitude of tremor-related activity, while thalamic nuclei function as resonance hubs integrating network oscillations and translating them into rhythmic motor output.</p><p><strong>Discussion: </strong>Conceptualizing parkinsonian tremor as a distributed network disorder helps explain several clinical observations, including the dissociation between tremor and other motor symptoms, variability in levodopa responsiveness, and heterogeneous tremor phenotypes. This framework also highlights the potential relevance of oscillatory biomarkers and network-based neuromodulation strategies, including adaptive deep brain stimulation, for future therapeutic approaches.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"40"},"PeriodicalIF":1.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Cala Trio-Induced Glossopharyngeal Neuralgia in a Patient with Essential Tremor and Idiopathic Parkinson's Disease.","authors":"Moriah R Arnold, Amie L Hiller","doi":"10.5334/tohm.1224","DOIUrl":"10.5334/tohm.1224","url":null,"abstract":"<p><strong>Background: </strong>Cala Trio is a wrist-worn transcutaneous afferent patterned stimulation (TAPS) device for essential tremor (ET), delivering high-frequency stimulation to the median and radial nerves.</p><p><strong>Case report: </strong>We report the first case of glossopharyngeal neuralgia (GPN) associated with Cala Trio initiation in a 69-year-old male with ET and Parkinson's disease, with prior GPN. Throat spasms triggered by swallowing and coughing began after initiation on two trials and resolved with discontinuation; evaluation was unrevealing.</p><p><strong>Discussion: </strong>We review TAPS mechanisms, GPN neuroanatomy, and circuit-level links between peripheral nerve stimulation and brainstem cranial nerve hyperexcitability, highlighting a novel adverse event and need for caution in patients with prior GPN.</p><p><strong>Highlights: </strong>We report the first case of glossopharyngeal neuralgia associated with Cala Trio TAPS therapy in a patient with essential tremor and Parkinson's disease. Symptoms were temporally linked to device use and resolved upon discontinuation, suggesting a reversible neuromodulation-related effect and expanding the safety profile of peripheral tremor therapies.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"41"},"PeriodicalIF":1.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential Tremor and Digital Biomarkers: A Scoping Review Using the TRACE Framework to Map Readiness for Clinical Trials and Routine Practice.","authors":"David Ledingham, Antonella Macerollo, Nicola Pavese","doi":"10.5334/tohm.1205","DOIUrl":"10.5334/tohm.1205","url":null,"abstract":"<p><strong>Background: </strong>Essential Tremor (ET) is the most prevalent movement disorder in adults yet remains underrepresented in digital biomarker research. As therapies evolve, the absence of validated digital endpoints represents a growing translational gap. We introduce TRACE (Technology Readiness And Clinical Evidence), a novel five-tier validation maturity framework, and apply it in a scoping review of the ET digital biomarker literature.</p><p><strong>Methods: </strong>A PRISMA-ScR scoping review was conducted across four databases (2000-2025). Studies were eligible if they reported quantitative digital tremor measurement in ten or more ET participants. Each study was assigned to the highest satisfied TRACE tier: technical verification (T1), referenced clinical validity (T2), ambulatory and longitudinal utility (T3), clinical trial readiness (T4), or economic and implementation readiness (T5).</p><p><strong>Results: </strong>One hundred and sixty-five studies were included: wearable inertial measurement units (n = 114), digitised handwriting (n = 16), computer vision (n = 15), surface EMG (n = 10), voice (n = 6), and gait (n = 4). One hundred and fifty-four (93%) were T2; nine T3; two T4, both deploying the Cala Health TAPS wristband; none T5. Home or ambulatory deployment was present in 13 studies, minimum detectable change data in three, and patient-reported outcome correlation in 11.</p><p><strong>Discussion: </strong>Only 11 studies across two modalities were classified beyond T2, demonstrating ambulatory or longitudinal evidence beyond supervised clinical validation; the TAPS wristband is the sole platform to achieve Tier 4. Home deployment, minimum detectable change derivation anchored to patient experience, and patient-reported outcome integration remain key prerequisites before digital tremor metrics can function as trial endpoints or inform routine practice.</p><p><strong>Highlights: </strong>Despite rapid advances in digital outcome measures for Parkinson's disease, essential tremor remains largely overlooked. Reviewing 165 studies across six sensing modalities, we introduce TRACE, a five-tier validation framework, and find that while 93% of devices demonstrate basic clinical validity, only two achieve clinical trial readiness.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"39"},"PeriodicalIF":1.9,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Intention Tremor Trajectories in Essential Tremor: A Comment.","authors":"Muhammad Saqib Khan, Syed Huzaifa Khan","doi":"10.5334/tohm.1193","DOIUrl":"10.5334/tohm.1193","url":null,"abstract":"<p><p>We read with interest the recent prospective study by Louis et al. examining longitudinal changes in intention tremor severity in essential tremor. The study provides valuable data addressing an important and previously understudied question regarding whether intention tremor worsens over time. While the findings demonstrate a significant group-level increase in intention tremor severity, we urge caution in extending these clinical observations to conclusions about progressive cerebellar degeneration. In the absence of direct structural, imaging, or pathological evidence, longitudinal progression of a cerebellar-related clinical sign does not necessarily confirm underlying neurodegenerative changes. Furthermore, the substantial heterogeneity observed in tremor trajectories, with a considerable proportion of patients showing stable or improved intention tremor, suggests that progression is not uniform and may reflect phenotypic variability within essential tremor rather than a universal degenerative process. Future studies incorporating direct measures of cerebellar structure and function, along with longer follow-up and phenotypic stratification, will be important to clarify the relationship between intention tremor progression and underlying cerebellar pathology.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"38"},"PeriodicalIF":1.9,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Focal Low-Energy Extracorporeal Shock Wave Treatment (ESWT) as an Add-On to Botulinum Toxin (BoNT) Injection on Pisa Syndrome in Parkinson's Disease.","authors":"Paolo Manganotti, Tiziana Maria Isabella Lombardo, Valentina Cenacchi, Mauro Catalan, Giulia Bellavita, Valentina Tommasini, Arianna Sartori","doi":"10.5334/tohm.1201","DOIUrl":"10.5334/tohm.1201","url":null,"abstract":"<p><strong>Background: </strong>Pisa syndrome (PS) is a reversible lateral trunk deviation that arises as a complication in a subset of patients with Parkinson's disease (PD). Effective therapeutic options remain limited, and standardized protocols are lacking. Extracorporeal shock wave therapy (ESWT), an intervention with emerging antidystonic and antispastic properties, has shown promising effects on muscle spasms and dystonia. We aimed at evaluating the feasibility, safety, and preliminary therapeutic effects of ESWT combined with botulinum toxin (BoNT) for reducing paraspinal muscle tone and pain in patients with PS.</p><p><strong>Methods: </strong>This crossover observational study analyzed data collected in routine clinical practice in patients with PS undergoing focused ESWT applied to ipsilateral paraspinal muscles immediately prior to BoNT injections.Fifteen patients were enrolled, and eleven completed the full protocol, which included ESWT+BoNT and sham ESWT+BoNT administered according to clinical scheduling, with a washout phase lasting no less than 3 months between treatment conditions. Clinical evaluations were performed at baseline, immediately post-treatment, and at 1 and 3 months post-treatment. Outcome measures included lateral trunk flexion angle, UPDRS part III scores, pain intensity ratings, quality of life assessments, and surface electromyography (sEMG) of axial muscles.</p><p><strong>Results: </strong>The primary finding was a significant immediate reduction in lateral trunk flexion following active ESWT compared with sham (p = 0.038). However, no sustained effects were observed at 1 or 3 month post-treatment for posture, motor severity, pain, or patient-reported outcomes. sEMG analysis did not demonstrate significant modifications in muscle activation patterns. ESWT was well tolerated, only mild, transient discomfort was reported, and no systemic adverse events occurred.</p><p><strong>Discussion: </strong>These findings provide evidence that focused ESWT may acutely reduce lateral trunk flexion in PS when used as an adjunct to BoNT. Larger studies are warranted to better define its therapeutic potential.</p>","PeriodicalId":23317,"journal":{"name":"Tremor and Other Hyperkinetic Movements","volume":"16 ","pages":"37"},"PeriodicalIF":1.9,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}