Botulinum Toxins; Dystonia; Electrophysiology; Movement Disorders; Muscle Spasticity; Neurology; Parkinson Disease; Tremor; Dyskinesias; Deep Brain Stimulation
My current research is focused to improve a number of movement disorders and pain disorders with the use of botulinum toxins (subcutaneous or intramuscular treatment).
Specialized Terms: Parkinson's disease; Movement disorders (dystonia, tremor, chores, tics , tardive dyskinesias); New indications for botulinum toxin treatment in clinical medicine (variety of pain disorders, spasticity and rigidity, etc); Central and peripheral electrophysiology (EEG/EMG); Deep brain stimulation
Extensive Research Description
My scientific interest in botulinum neurotoxin research is based on the wide range of synaptic mechanisms through which these toxins exert their functions. Since botulinum toxins also inhibit the release of acetylcholine from presynaptic vesicles, they can improve hyperkinetic disorders. This is the basis for studying the effect of incobotulinum toxin-A (Xeomin) in Parkinsonian and essential tremor. Previous studies of botulinum toxin A have demonstrated the efficacy of intramuscular onabotulinum toxin A in reducing the tremor of essential tremor, but the results were confounded by development of finger weakness in 30% of these patients. Our current protocols apply a customized pattern of injection (rather than fixed injection) and smaller doses given to more muscles under EMG guidance. This approach will hopefully avoid muscle weakness. In restless legs syndrome, foot movements are dorsiflexion/plantar flexion. Our restless legs syndrome protocol explores the effect of incobotulinum toxin-A by injecting xeomin into gastrocnemius and tibialis anterior muscles. One of our other major areas of interest is in pain research, as both type A and B toxins inhibit the release of pain modulators (substance P, calcitonin gene related peptide, glutamate and bradykinin) from presynaptic vesicles. Two of our current protocols assess the efficacy of incobotulinum toxin-A (Xeomin) in low back pain and abobotulinum toxin-A on post-radiation and post-surgical pain.
We are involved in several protocols involving patients with movement disorders:
1. Evaluation of efficacy of botulinum toxin-A (Xeomin) in Parkinsonian tremor (PI: Jabbari)
This is a double blind, parallel design, randomized study of adult patients with Parkinson’s resting tremor, which involves xeomin injection into forearm and hand muscles under EMG guidance.
2. Evaluation of efficacy of botulinum toxin-A (Xeomin) in treatment of restless legs syndrome (PI: Jabbari)
This is a double blind, randomized, cross over study of adult patients with restless legs syndrome. Xeomin is injected into the tibialis anterior and gastrocnemius muscles.
3. Evaluation of efficacy of botulinum toxin-A (Xeomin) in essential tremor (PI: Machado and co-PI: Jabbari)
This is a double blind, parallel design, randomized study of adult patients with essential tremor in which xeomin is injected into forearm and hand muscles under EMG guidance
4. A phase II, multi-center, open label, study to evaluate the efficacy and safety of WTX101 (a new copper depleter) in adult patients with Wilson’s Disease (PI: Schiltsky and co-PI: Jabbari)
see research description
- Mittal S, Machado DG, Jabbari OnabotulinumtoxinA for Treatment of Focal Cancer Pain After Surgery and/or Radiation. Pain Med. 2012;13:1029-33.
- Jabbari B, Machado D. Treatment of Refractory Pain with Botulinum Toxins-An Evidence-Based Review. Pain Med. 2011: 12:1594-1606
- Botulinum neurotoxins in the treatment of refractory pain. Jabbari B. Nat Clin Pract Neurol. 2008 Dec;4(12):676-85.