{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T20:59:31Z","timestamp":1782421171391,"version":"3.54.5"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Proximal upper limb tremor is a common, functionally disabling condition. Medical therapy is often ineffective. IncobotulinumtoxinA can significantly improve tremor with minimal adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We aimed to compare clinical, functional, and quality of life measures in patients with proximal upper limb tremor following incobotulinumtoxinA treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We undertook a double\u2010blind, randomized two\u2010sequence, two\u2010period, two\u2010treatment, placebo\u2010controlled cross\u2010over trial. Twenty adult patients with proximal upper limb tremor were recruited from a tertiary movement disorders clinic. Patients were randomized 1:1 to alternate electromyographically guided intramuscular injections of either incobotulinumtoxinA or saline to the dominant upper limb using computer\u2010generated randomization. Patients were injected at baseline, then 4\u2009months after cross\u2010over. Primary outcome was change in Goal Attainment Rating Scale (GARS) at two\u2010months post intervention. Secondary outcomes were dominant upper limb The Essential Tremor Rating Assessment Scale (TETRAS), Fahn\u2010Tolosa\u2010Marin tremor rating scale (FTM\u2010TRS) and three patient\u2010related outcome measures. Outcomes were assessed at baseline and monthly intervals for 3\u2010months post each intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no significant improvement in the <jats:styled-content style=\"fixed-case\">GARS<\/jats:styled-content> at 2\u2010months post injection (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.83, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.14\u201324.32). Secondary outcomes showed a mean reduction in <jats:styled-content style=\"fixed-case\">TETRAS<\/jats:styled-content> score of \u22121.05 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22121.99 to \u22120.13) and <jats:styled-content style=\"fixed-case\">FTM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TRS<\/jats:styled-content> of \u22126.84 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221212.37 to \u22121.31) in those receiving <jats:styled-content style=\"fixed-case\">incobotulinumtoxinA<\/jats:styled-content>. There was no significant change in patient\u2010rated outcome scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Single dose incobotulinumtoxinA injections are effective in reducing objective measures of proximal upper limb tremor and function. This did not translate into improved patient\u2010rated outcomes in this single therapeutic dose study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.70079","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T05:14:14Z","timestamp":1745558054000},"page":"1293-1301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Randomized, Double\u2010Blind, Placebo Controlled, Crossover Trial of <scp>incobotulinumtoxinA<\/scp> Treatment for Upper Limb Tremor"],"prefix":"10.1002","volume":"12","author":[{"given":"Sai A.","family":"Nagaratnam","sequence":"first","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Wilson","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0768-0059","authenticated-orcid":false,"given":"Han\u2010Lin","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of General Neurology Neurological Institute, Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence C.F.","family":"Chang","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales Australia"},{"name":"Sydney Medical School University of Sydney  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Qiu","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Silsby","sequence":"additional","affiliation":[{"name":"Sydney Medical School University of Sydney  Camperdown New South Wales Australia"},{"name":"Department of Neurophysiology Westmead Hospital  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro F.","family":"Fois","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Martin","sequence":"additional","affiliation":[{"name":"Movement Disorders Unit, Department of Neurology Westmead Hospital  Westmead New South Wales 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