{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:06:06Z","timestamp":1788519966787,"version":"build-2803163510"},"reference-count":77,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"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>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 \u201cbotulinum toxin\u201d and \u201ctremor\u201d. 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 \u201casymmetric\u201d 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.<\/jats:p>","DOI":"10.3390\/toxins16090392","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T11:29:59Z","timestamp":1726226999000},"page":"392","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Use of Botulinum Toxin in Upper-Limb Tremor: Systematic Review and Perspectives"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8292-8109","authenticated-orcid":false,"given":"Damien","family":"Motavasseli","sequence":"first","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Service de R\u00e9\u00e9ducation Neurolocomotrice, H\u00f4pitaux Universitaires Henri Mondor, F-94010 Cr\u00e9teil, France"},{"name":"UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Universit\u00e9 Paris Est Cr\u00e9teil (UPEC), F-94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Delorme","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Institut de Neurologie, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, F-75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3726-2712","authenticated-orcid":false,"given":"Nicolas","family":"Bayle","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Service de R\u00e9\u00e9ducation Neurolocomotrice, H\u00f4pitaux Universitaires Henri Mondor, F-94010 Cr\u00e9teil, France"},{"name":"UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Universit\u00e9 Paris Est Cr\u00e9teil (UPEC), F-94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Gracies","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Service de R\u00e9\u00e9ducation Neurolocomotrice, H\u00f4pitaux Universitaires Henri Mondor, F-94010 Cr\u00e9teil, France"},{"name":"UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Universit\u00e9 Paris Est Cr\u00e9teil (UPEC), F-94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Roze","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Institut de Neurologie, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, F-75013 Paris, France"},{"name":"Paris Brain Institute, INSERM, CNRS, Sorbonne University, F-75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolaine","family":"Baude","sequence":"additional","affiliation":[{"name":"Assistance Publique H\u00f4pitaux de Paris, Service de R\u00e9\u00e9ducation Neurolocomotrice, H\u00f4pitaux Universitaires Henri Mondor, F-94010 Cr\u00e9teil, France"},{"name":"UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Universit\u00e9 Paris Est Cr\u00e9teil (UPEC), F-94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jama.2014.1397","article-title":"Tremor","volume":"311","author":"Elias","year":"2014","journal-title":"JAMA"},{"key":"ref_2","first-page":"32","article-title":"Keys to identifying and treating tremor","volume":"57","author":"Velickovic","year":"2002","journal-title":"Mov. 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