SynthesisMovement disorders clinical practice2026
Botulinum Toxin Efficacy in Upper Limb Tremor: A Systematic Review and Meta-Analysis.
Synthesis in Movement disorders clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundEssential tremor (ET) and dystonic tremor syndrome (DTS) can be treated using botulinum toxin (BoNT) injections. Previous reviews lacked an assessment of the certainty of evidence and focused solely on clinician-reported outcomes. Additionally, studies have demonstrated interindividual variability in BoNT efficacy.
objectiveThe aim of the study was to assess the efficacy and safety of BoNT injections for ET and DTS of the upper limbs, and to identify factors associated with BoNT efficacy.
methodsWe systematically searched Pubmed, Embase, Cochrane Library, and Web of Science databases for studies on BoNT injections in ET and DTS of the upper limbs. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Outcomes from randomized controlled trials (RCTs) were pooled as standardized mean differences (SMDs).
resultsWe identified 5 RCTs, 6 open-label trials, and 6 retrospective cohort studies. Meta-analysis of post-intervention scores showed a moderate effect on patient-reported change (SMD: 0.58 [95% confidence interval [CI]: 0.39, 0.78]), no effect on clinically rated tremor severity (SMD: 1.69 [95% CI: -3.80, 0.42]), and no effect on grip strength (SMD: -0.63 [95% CI: -1.37, 0.10]). In contrast, meta-analysis using change-from-baseline scores showed an improvement of clinically rated tremor severity (SMD: -1.12 [95% CI: -1.70, -0.54]). Certainty of evidence ranged from low to very low. No clear associations between BoNT efficacy and tremor phenotypes or injection strategies were identified.
conclusionsPatient-tailored BoNT injections may be effective and safe for ET and DTS. More trials are needed to confirm efficacy and safety, identify which tremor phenotypes benefit the most, and optimize injection strategies.
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