In the area of dystonia treatment, we continue to provide botulinum toxin injections to our patients while training physicians to perform these injections. Past studies from our group have shown that certain rehabilitation techniques, such as motor training and sensory training can be therapeutic. We have completed a new project for patients with writers cramp combining botulinum toxin and rehabilitation that might be more efficacious, and some secondary endpoints of the study suggest that this might well be the case. We have also been developing a new scale for severity of writers cramp to help in the analysis of clinical trials. Another protocol has begun of Deep Brain Stimulation (DBS) for focal hand dystonia. New treatments are needed for essential tremor. One promising agent is 1-octanol and its metabolite, 1-octanoic acid, which we continue to develop. We have characterized the pharmacokinetics and compared the efficacy of different formulations in a dose escalation and cross-over study in patients with essential tremor. We have completed a study with 1-octanoic acid, seeking the maximum tolerated dose. We are initiating studies of non-invasive brain stimulation for functional movement disorders.
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