{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:26:57Z","timestamp":1791606417700,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T00:00:00Z","timestamp":1531958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>The aim of this study is to review our longitudinal experience with onabotulinumtoxinA (onaBoNT-A) injections for medically refractory hand tremor. We performed a retrospective review of our database of patients treated with onaBoNT-A for hand tremor evaluated between 2010 and 2018 in at least 2 sessions with follow-up. The majority were injected into the forearm flexors (FF), although treatment was individualized. During the specified period, 91 patients (53 essential tremor, 31 dystonic tremor, 6 Parkinson\u2019s disease tremor, and 1 cerebellar outflow tremor) met our inclusion criteria. The mean age (SD) was 64.8 years (12.8), and mean duration of follow-up was 29.6 months (25.1) with mean of 7.7 (6.3) treatment visits. FF were injected in 89 (97.8%) patients, exclusively in 74 (81.3%), and 15 (16.5%) were injected in FF and other muscles. EMG guidance was used in 5 patients (5.5%). On a 0\u20134 \u201cpeak effect\u201d rating scale (0 = no effect, 4 = marked improvement in severity and function), 80.2% and 85.7% of patients reported moderate or marked improvement (score 3 or 4) at their first and last follow-up visit, respectively. There was no statistically significant difference in the outcomes between first and last visit: average \u201cpeak effect\u201d rating score (3.2 versus 3.4), \u201cglobal\u201d rating score (3.0 versus 3.2), latency of response (4.5 versus 3.8 days), and total duration of response (12.7 versus 12.8 weeks), except onaBoNT-A dose (65.0 versus 78.6 U\/limb, p = 0.002). Of 1095 limb injections, there were 134 (12.2%) non-disabling and transient (mean 36 days) adverse events (132 limb weakness, 2 pain). OnaBoNT-A injections are safe and effective in the treatment of hand tremor.<\/jats:p>","DOI":"10.3390\/toxins10070299","type":"journal-article","created":{"date-parts":[[2018,7,20]],"date-time":"2018-07-20T02:10:11Z","timestamp":1532052611000},"page":"299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Botulinum Toxin for the Treatment of Hand Tremor"],"prefix":"10.3390","volume":"10","author":[{"given":"Nicki","family":"Niemann","sequence":"first","affiliation":[{"name":"Parkinson\u2019s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,7,19]]},"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":"729","DOI":"10.1016\/j.parkreldis.2015.04.019","article-title":"Tremor-related quality of life: A comparison of essential tremor vs. Parkinson\u2019s disease patients","volume":"21","author":"Louis","year":"2015","journal-title":"Park. Relat. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/mds.22838","article-title":"How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor","volume":"25","author":"Louis","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/mds.25945","article-title":"The prevalence of Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"29","author":"Pringsheim","year":"2014","journal-title":"Mov. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S162","DOI":"10.1016\/j.parkreldis.2015.09.032","article-title":"The relationship between essential tremor and Parkinson\u2019s disease","volume":"22","author":"Thenganatt","year":"2016","journal-title":"Park. Relat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1095","DOI":"10.1212\/WNL.0000000000005215","article-title":"The nature of postural tremor in Parkinson disease","volume":"90","author":"Dirkx","year":"2018","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/mdc3.12329","article-title":"How Do I Examine for Re-Emergent Tremor?","volume":"3","author":"Jankovic","year":"2016","journal-title":"Mov. Disord. Clin. Pract."},{"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":"3","DOI":"10.1016\/j.parkreldis.2016.03.024","article-title":"Tremor in dystonia","volume":"29","author":"Pandey","year":"2016","journal-title":"Park. Relat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S1353-8020(11)70030-X","article-title":"Tremor revisited: Treatment of PD tremor","volume":"18","author":"Vingerhoets","year":"2012","journal-title":"Park. Relat. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s13311-013-0230-5","article-title":"The treatment of tremor","volume":"11","author":"Schneider","year":"2014","journal-title":"Neurotherapeutics"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Buhmann, C., Huckhagel, T., Engel, K., Gulberti, A., Hidding, U., Poetter-Nerger, M., Goerendt, I., Ludewig, P., Braass, H., and Choe, C.U. (2017). Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178984"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2016.01.014","article-title":"Movement disorders induced by deep brain stimulation","volume":"25","author":"Jankovic","year":"2016","journal-title":"Park. Relat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1136\/jnnp-2017-316301","article-title":"Functional lesional neurosurgery for tremor: Back to the future?","volume":"89","author":"Schreglmann","year":"2018","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1080\/14737175.2018.1445526","article-title":"Surgical treatments for essential tremor","volume":"18","author":"Elble","year":"2018","journal-title":"Expert Rev. Neurother."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mohammed, N., Patra, D., and Nanda, A. (2018). A meta-analysis of outcomes and complications of magnetic resonance-guided focused ultrasound in the treatment of essential tremor. Neurosurg. Focus, 44.","DOI":"10.3171\/2017.11.FOCUS17628"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1002\/mds.25582","article-title":"Diffusion, spread, and migration of botulinum toxin","volume":"28","author":"Jankovic","year":"2013","journal-title":"Mov. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.toxicon.2017.09.003","article-title":"An update on new and unique uses of botulinum toxin in movement disorders","volume":"147","author":"Jankovic","year":"2018","journal-title":"Toxicon"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.toxicon.2014.07.009","article-title":"Long-term efficacy, safety, and side effect profile of botulinum toxin in dystonia: A 20-year follow-up","volume":"90","author":"Jankovic","year":"2014","journal-title":"Toxicon"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Samotus, O., Rahimi, F., Lee, J., and Jog, M. (2016). Functional ability improved in essential tremor by incobotulinumtoxinA injections using kinematically determined biomechanical patterns\u2014A new future. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153739"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rahimi, F., Samotus, O., Lee, J., and Jog, M. (2015). Effective management of upper limb parkinsonian tremor by incobotulinumtoxinA injections using sensor-based biomechanical patterns. Tremor Other Hyperkinet. Mov., 5.","DOI":"10.5334\/tohm.240"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.mayocp.2017.06.010","article-title":"Botulinum toxin in Parkinson disease tremor: A randomized, double-blind, placebo-controlled study with a customized injection approach","volume":"92","author":"Mittal","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_23","unstructured":"Jog, M., Lee, J., Althaus, M., Scheschonka, A., Dersch, H., Simpson, D.M., and ET Study Team (2017). Efficacy and safety of incobotulinumtoxinA (inco\/A) for essential tremor using kinematics-guided clinical decision support: A randomized, double-blind, placebo-controlled trial. Mov. Disord., 32, Available online: http:\/\/www.mdsabstracts.org\/abstract\/efficacy-and-safety-of-incobotulinumtoxina-incoa-for-essential-tremor-using-kinematics-guided-clinical-decision-support-a-randomized-double-blind-placebo-controlled-trial\/."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1002\/mds.25739","article-title":"Treatment of proximal upper limb tremor with botulinum toxin therapy","volume":"29","author":"Kim","year":"2014","journal-title":"Mov. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mittal, S.O., Machado, D., Richardson, D., Dubey, D., and Jabbari, B. (2018). Botulinum toxin in essential hand tremor\u2014A randomized double-blind placebo-controlled study with customized injection approach. Park. Relat. Disord.","DOI":"10.1016\/j.parkreldis.2018.06.019"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1212\/WNL.41.8.1185","article-title":"Botulinum toxin treatment of tremors","volume":"41","author":"Jankovic","year":"1991","journal-title":"Neurology"},{"key":"ref_27","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_28","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_29","doi-asserted-by":"crossref","unstructured":"Jankovic, J. (2013). The use of botulinum toxin in tic disorders and essential hand and head tremor. Manual of Botulinum Toxin Therapy, Cambridge University Press. [2nd ed.].","DOI":"10.1017\/CBO9781139178068.019"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1017\/S031716710001489X","article-title":"Effectiveness of BoNT A in Parkinson\u2019s disease upper limb tremor management","volume":"40","author":"Rahimi","year":"2013","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1017\/cjn.2017.260","article-title":"Botulinum toxin type A injections as monotherapy for upper limb essential tremor using kinematics","volume":"45","author":"Samotus","year":"2018","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Samotus, O., Lee, J., and Jog, M. (2017). Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178670"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zakin, E., and Simpson, D. (2017). Botulinum toxin in management of limb tremor. Toxins, 9.","DOI":"10.3390\/toxins9110365"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Karp, B., and Alter, K. (2017). Muscle selection for focal limb dystonia. Toxins, 10.","DOI":"10.3390\/toxins10010020"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s100720070049","article-title":"Botulinum toxin treatment for functional disability induced by essential tremor","volume":"21","author":"Pacchetti","year":"2000","journal-title":"Neurol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.parkreldis.2009.05.003","article-title":"Motor overflow and mirror dystonia","volume":"15","author":"Sitburana","year":"2009","journal-title":"Park. Relat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wu, C., Xue, F., Chang, W., Lian, Y., Zheng, Y., Xie, N., Zhang, L., and Chen, C. (2016). Botulinum toxin type A with or without needle electromyographic guidance in patients with cervical dystonia. Springerplus, 5.","DOI":"10.1186\/s40064-016-2967-x"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1002\/mus.1186","article-title":"Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is rarely required","volume":"24","author":"Jankovic","year":"2001","journal-title":"Muscle Nerve"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1586\/14737175.7.6.637","article-title":"Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinson\u2019s disease","volume":"7","author":"Sheffield","year":"2007","journal-title":"Expert Rev. Neurother."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/10\/7\/299\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:13:00Z","timestamp":1760195580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/10\/7\/299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,19]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,7]]}},"alternative-id":["toxins10070299"],"URL":"https:\/\/doi.org\/10.3390\/toxins10070299","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,19]]}}}