The scientific aim of this study is to investigate the efficacy and safety of
incobotulinumtoxinA (Xeomin-Merz Pharmaceuticals) in the tremor of Parkinson‟s disease. Our
hypothesis is that injection of Xeomin into the muscles of arm, forearm and hand decreases
the tremor amplitude and frequency leading to improvement of the patient‟s function.
This is an investigator initiated, randomized, double blind, placebo controlled, cross over
study which is supported by Merz pharmaceuticals. Patients with Parkinson‟s disease (at Yale
Neurology and Movement disorders clinics) will be approached by the members of the research
team (PI and sub-investigators) to see if they meet inclusion and exclusion criteria and
wish to participate in the study.
If eligible and consented to participate in the study, there will be a series of
questionaires, examinations and treatment sessions.
1. Age more than 18 years
2. Both sexes
3. all races/ethnic groups.
4. Meeting the clinical diagnosis of Parkinson's disease with presence of moderate to
severe Parkinson tremor that is refractory to standard medical treatments and which
limits the patient‟s functionality and/or poses significant discomfort.
5. Subjects who are able to read, speak, and understand English.
1. Existing significant acute medical condition (i.e. cardiovascular, endocrine,
hematologic, neoplastic, infectious, or autoimmune disorders) or significant
swallowing or breathing difficulties.
2. Pregnancy or planned pregnancy (determined by urine pregnancy test).
3. Active breast feeding.
4. Enrollment in any clinical trial (currently or within the past 3 months) in which
treatments are imposed by a protocol.
5. Any subject for whom botulinum toxin treatment would be contraindicated; known
allergy or sensitivity to medication.
6. Subjects who are younger than 18 years of age. Neuromuscular-junction disorders.
7. Evidence of acute pathology in neuro-imaging.
8. Axis I diagnosis determined by a neurologist or psychiatrist.
9. Use of Anesthetic medications within two weeks and corticosteroid injections within 4
weeks of enrollment.
10. Those who received botulinum toxin injections in the past 4 months.