Objective: This systematic review aims to evaluate the outcomes of neurotoxins such as botulinum neurotoxin (BoNT) injections as a therapeutic intervention for essential tremors with the goal of determining its efficacy and safety as part of a comprehensive treatment approach for this common and debilitating disorder.

Background: Essential Tremor (ET) is a chronic, progressive condition classically affecting the hands and arms, is typically bilateral, and may be slightly asymmetric. Tremor related disability can significantly significantly impact mood and quality of life. Disease progression and patient related factors may limit efficacy and use of traditional pharmacologic options. Neurotoxin injections offer a promising approach for managing symptoms that are resistant to conventional treatments.

Method: Following PRISMA guidelines, a systematic literature search was conducted on PubMed, Cochrane, HERDIN, and ScienceDirect on March 2025. The following search string was used (“Essential tremor” OR “tremor disorder”) AND (“botulinum toxin” OR “neurotoxin” OR “botulinum toxin A” OR “BoNT-B”) AND (“efficacy” OR “safety” OR “treatment”). All articles published prior to December 2024 were included.

Results: Of 8,963 records, 18 studies were included in the final analysis: eight open label studies, five randomized clinical trials, three retrospective studies, and two prospective crossover studies. The studies looked at ET manifesting as upper limb tremor (n=12), voice tremor (n=4), and head tremor (n=2). Among patients receiving botulinum toxin (BoNT)] , majority experienced reduction in tremor amplitude and severity as measured by the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM) and Clinical Global Impression (CGI), with improvement in quality-of-life as measured by the Quality of Life in Essential Tremor Questionnaire (QUEST). Adverse effects, such as localized muscle weakness, pain on injection site, hoarseness and dysphagia, were generally dose-dependent and tolerable.

Conclusion: Neurotoxin injections demonstrated significant efficacy in reducing tremor severity and may be a promising approach for those experiencing symptoms that are refractory to conventional oral medications. across various body regions.

PRISMA flow diagram

Summary of effectiveness

Summary of adverse effects

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-safety-and-quality-of-life-outcomes-of-neurotoxin-injections-in-the-treatment-of-essential-tremors-a-systematic-review/