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. 2024 Sep 13;16(9):392.
doi: 10.3390/toxins16090392.

Use of Botulinum Toxin in Upper-Limb Tremor: Systematic Review and Perspectives

Damien Motavasseli  1   2 , Cécile Delorme  3 , Nicolas Bayle  1   2 , Jean-Michel Gracies  1   2 , Emmanuel Roze  3   4 , Marjolaine Baude  1   2
Affiliations

Use of Botulinum Toxin in Upper-Limb Tremor: Systematic Review and Perspectives

Damien Motavasseli et al. Toxins (Basel). .

Abstract

Background: Tremor is the most common movement disorder, with significant functional and psychosocial consequences. Oral medications have been disappointing or limited by side effects. Surgical techniques are effective but associated with risks and adverse events. Botulinum toxin (BT) represents a promising avenue but there is still no double-blind evidence of efficacy on upper limb function. A systematic review on the effects of BT in upper-limb tremor was conducted.

Methods: A systematic search of the literature was conducted up to July 2023, including the keywords "botulinum toxin" and "tremor". All randomized controlled trials (RCTs) and open-label studies were analyzed. Independent reviewers assessed their methodological quality.

Results: There were only eight published RCTs and seven published open-label studies, with relatively small sample sizes. This review suggests that BT is more effective when injections are patient-tailored, with analyses based on clinical judgement or kinematics. Subjective and objective measures frequently improve but transient weakness may occur after injections, especially if wrist or fingers extensors are targeted. A number of studies had methodological limitations.

Conclusions: The authors discuss how to optimize tremor assessments and effects of BT injection. Controlled evidence is still lacking but it is suggested that distal "asymmetric" BT injections (targeting flexors/pronators while sparing extensors/supinators) and proximal injections, involving shoulder rotators when indicated, may avoid excessive weakness while optimizing functional benefit.

Keywords: action tremor; ataxia; botulinum toxin; cerebellar; dystonic tremor; essential tremor; resting tremor; tremor.

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Conflict of interest statement

All the authors of the manuscript are or have been consultants for Merz Pharma, Ipsen and Abbvie, but received no specific compensation for this manuscript. J.-M.G. received consulting honoraria by Ipsen, Ltd., Fastox, and Merz and Abbvie. E.R. declares that he also received speech honoraria from Orkyn, Aguettant, Elivie, Merz Pharma, and Janssen and for participating in advisory boards from Merz Pharma, Elivie, Teva, and BIAL. He received research support from Merz Pharma, Orkyn, Aguettant, Elivie, Ipsen, Everpharma, Enjoysharing, Fondation Desmarest, AMADYS, ADCY5.org, Fonds de dotation Patrick Brou de Laurière, Agence Nationale de la Recherche, Dystonia Medical Reasearch Foundation, Hope For Annabel, Cure Alternating Hemiplegia of Childhood Alternating Hemiplegia of Childhood Foundation, Alternating Hemiplegia of Childhood Association of Iceland, Association française de l’hémiplégie alternante, and Alternating Hemiplegia of Childhood Kids of Netherlands.

Figures

Figure 1
Figure 1
Flowchart of study selection.
See this image and copyright information in PMC

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