{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:20:36Z","timestamp":1769599236894,"version":"3.49.0"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Tremor is part of the phenomenological spectrum of dystonia. Treatments available for tremor in dystonia are oral medications (OM), botulinum neurotoxin (BoNT), and brain surgery (deep brain stimulation or thalamotomy). There is limited knowledge regarding the outcome of different treatment options, and evidence is especially scarce for the tremor of the upper limbs occurring in people with dystonia. In this single-center retrospective study, we evaluated the outcome of different treatments in a cohort of people with upper limb dystonic tremors. Demographic, clinical, and treatment data were analyzed. Dropout rates and side effects were specifically assessed, as well as the 7-point patient-completed clinical global impression scale (p-CGI-S, 1: very much improved; 7: very much worse) as outcome measures. A total of 47 subjects (46.8% female) with dystonic tremor, tremor associated with dystonia, or task-specific tremor were included, with a median age at onset of 58 years (7\u201386). A total of 31 subjects were treated with OM, 31 with BoNT, and 7 with surgery. Dropout rates with OM were 74.2% due to either lack of efficacy (n = 10) or side effects (n = 13). A total of 7 patients treated with BoNT (22.6%) had mild weakness, causing dropout in 2. P-CGI-S was \u22643 (improvement) in 39% with OM, compared to 92% with BoNT and 100% with surgery. These findings suggest good symptom control of the tremor of the upper limb in dystonia with BoNT and surgery, with higher rates of dropout and side effects with OM. Randomized controlled studies are needed to confirm our findings and provide further insight into better selecting suitable patients for BoNT or brain surgery.<\/jats:p>","DOI":"10.3390\/jcm12041427","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T01:48:56Z","timestamp":1676252936000},"page":"1427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Bel\u00e9n","family":"Gonz\u00e1lez-Herrero","sequence":"first","affiliation":[{"name":"Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George\u2019s University of London, London SW17 0RE, UK"},{"name":"Departamento de Medicina, Universidad Aut\u00f3noma de Barcelona (UAB), 08193 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria Antonella","family":"Di Vico","sequence":"additional","affiliation":[{"name":"Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erlick","family":"Pereira","sequence":"additional","affiliation":[{"name":"Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George\u2019s University of London, London SW17 0RE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Clinical and Basic Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London SE5 8AF, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-3639","authenticated-orcid":false,"given":"Francesca","family":"Morgante","sequence":"additional","affiliation":[{"name":"Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George\u2019s University of London, London SW17 0RE, UK"},{"name":"Dipartimento di Medicina Clinica e Sperimentale, University of Messina, 98122 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society","volume":"33","author":"Bhatia","year":"2018","journal-title":"Mov. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/mds.25475","article-title":"Phenomenology and classification of dystonia: A consensus update","volume":"28","author":"Albanese","year":"2013","journal-title":"Mov. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1136\/jnnp-2013-305876","article-title":"Rest and other types of tremor in adult-onset primary dystonia","volume":"85","author":"Erro","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/B978-0-444-52014-2.00050-1","article-title":"Task-specific tremor","volume":"100","author":"Bain","year":"2011","journal-title":"Handb. Clin. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1002\/mds.28579","article-title":"The Signature of Primary Writing Tremor Is Dystonic","volume":"36","author":"Latorre","year":"2021","journal-title":"Mov. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"684835","DOI":"10.3389\/fneur.2021.684835","article-title":"Tremor Syndromes: An Updated Review","volume":"12","author":"Lenka","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1001\/jamaneurol.2020.4766","article-title":"Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor: A Randomized Clinical Trial","volume":"78","author":"Rajan","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1136\/jnnp-2013-305532","article-title":"The treatment of dystonic tremor: A systematic review","volume":"85","author":"Fasano","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/mds.21412","article-title":"Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor","volume":"22","author":"Stacy","year":"2007","journal-title":"Mov. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1002\/mds.25162","article-title":"Reliability of a new scale for essential tremor","volume":"27","author":"Elble","year":"2012","journal-title":"Mov. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.parkreldis.2005.05.009","article-title":"Quality of life in Essential Tremor Questionnaire (QUEST): Development and initial validation","volume":"11","author":"Pahwa","year":"2005","journal-title":"Park. Relat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/BF01530764","article-title":"Goal attainment scaling: A general method for evaluating comprehensive community mental health programs","volume":"4","author":"Kiresuk","year":"1968","journal-title":"Community Ment. Health J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1212\/WNL.56.11.1523","article-title":"A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor","volume":"56","author":"Brin","year":"2001","journal-title":"Neurology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/mds.870110306","article-title":"A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor","volume":"11","author":"Jankovic","year":"1996","journal-title":"Mov. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1212\/WNL.0b013e31825dcdd9","article-title":"A double-blind, randomized, controlled study of botulinum toxin type A in MS-related tremor","volume":"79","author":"Sung","year":"2012","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Anandan, C., and Jankovic, J. (2021). Botulinum Toxin in Movement Disorders: An Update. Toxins, 13.","DOI":"10.3390\/toxins13010042"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1073","DOI":"10.1212\/WNL.0000000000008875","article-title":"Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor","volume":"94","author":"Tsuboi","year":"2020","journal-title":"Neurology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/4\/1427\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:30:39Z","timestamp":1760121039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/4\/1427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12041427"],"URL":"https:\/\/doi.org\/10.3390\/jcm12041427","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,10]]}}}