Our fifth Melbourne Brain Centre Feature Week introduced the work of their Movement Disorders and Rehabilitation teams. To get us started, neurologist Dr Andrew Evans provided an introduction to the Movement Disorders team, outlining their work on using Botox to help treat symptoms, such as tremors, in people living with multiple sclerosis. Our second feature was a summary of a Cochrane Review paper completed by the Rehabilitations team (shown below). This overview was the precursor to a video with Professor Fary Khan, Director of Rehabilitation at the Royal Melbourne Hospital. Professor Khan explained how rehabilitation can treat spasticity in people living with multiple sclerosis, outlined the trials currently being undertaken by the team, and introduced the innovative, world class facilities at their disposal. NON PHARMACOLOGICAL INTERVENTIONS FOR TREATMENT OF SPASTICITY IN MULTIPLE SCLEROSIS (MS) Spasticity is a common and debilitating symptom, causing ‘stiffness’, ‘spasms’ or ‘tightness’ in the weakened limbs of people living with multiple sclerosis (MS). Overall, spasticity is difficult to treat. Current treatments include various medications (such as botulinium toxin or ‘botox’ injections to relax the affected muscles) and non drug methods aiming to achieve functional goals for patients (and their caregivers), such as physiotherapy, magnetic stimulation, electromagnetic therapy and vibration therapy. By the end of 2013, nine studies evaluating various non drug treatments to treat spasticity in adults living with MS had been undertaken, comprising a total of 341 participants. Results from these studies suggested that all included non pharmacological therapies have little or no evidence for improving spasticity in people living with MS. However, caution should be used in the interpretation of these results, due to the poor methodological quality of each of these studies. More research is needed to determine the usefulness of these interventions before they can be recommended as routine treatments. After Dr Andrew Evans explained the use of Botox to treat spasticity in people living with multiple sclerosis, our second research summary for the week looked at its use as a treatment for tremor. This research was led by Dr Anneke Van Der Walt, who discussed its findings in detail during the week’s Google Hangout. You can watch that discussion here. USING BOTOX TO TREAT TREMORS IN MULTIPLE SCLEROSIS Approximately two out of every three people with multiple sclerosis (MS) experience shaking or tremors in their arms or hands. These tremors can be quite debilitating, and can be quite severe in around 3-15% of cases. Whilst some studies have reported effective treatment of tremors with physical therapy or medications, the results of these investigations have been conflicting and have only been taken over short time periods. Separate studies have shown Botulinum toxin (Botox) provided positive outcomes when used as a treatment for spasticity in people with MS. Therefore, in a study by Van Der Walt et al, the use of Botox as a treatment for tremor in people with MS was assessed. The study looked at 23 people with MS who were given botulinum toxin type A injections or a saline placebo for three months. Then they received the opposite treatment for the next three months. The tremor severity and their ability to write and draw was measured before, during and after receiving the treatments. Video assessments were also taken every six weeks for six months. The study found that people saw significant improvement in tremor severity, writing and drawing at six weeks and three months after the botulinum toxin treatment, compared to after the placebo. In tremor severity, the participants improved an average of two points on a 10-point scale, bringing their tremor from moderate to mild. In writing and drawing, participants improved by an average of one point on a 10-point scale. Whilst this initial study was small, it supported a new method for the treatment of tremor in MS and provides the framework for larger studies. To finish the week, we featured two videos that introduced the “Hand Hub”, located at the Royal Park campus of the Royal Melbourne Hospital. In the first, Professor Mary Galea explained how this facility is being used by people with multiple sclerosis to improve their upper limb function and achieve a greater quality of life. In the second, senior occupational therapist, Marlena Klaic, introduced some of the rehabilitation activities in more detail.