In Brief |  Neurology

Trial of Botulinum Toxin for Isolated or Essential Head Tremor

Originally published in the New England Journal of Medicine, 9 November 23. This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information

Essential tremor, a common adult movement disorder, can lead to social isolation and work interference. While beta-blockers effectively treat limb tremors, head tremors pose challenges. However, limited evidence supports botulinum toxin used for head tremors, and it was this clinical gap that the researchers Marques & Pereira et al. set out to investigate.

In a double-blind, randomized trial, 117 adults with essential or isolated head tremors were assigned to receive botulinum toxin type A or a placebo. The injections, guided by electromyography, were administered on day 0 and during week 12 into the splenius capitis muscles. The botulinum toxin group received 75 IU on day 0 and a second injection (75 IU or 100 IU) at week 12, while the placebo group received placebo injections.

At week 18, 31% in the botulinum toxin group achieved at least a 2-point improvement on the Clinical Global Impression of Change scale, compared to 9% in the placebo group. Secondary outcomes supported this finding at 6 and 12 weeks. Adverse events occurred in about half of the botulinum toxin group but only 16% in the placebo group.

The researchers concluded that in patients with isolated or essential head tremor, electromyography-guided botulinum toxin injections on day 0 and week 12 led to better clinical improvement compared to placebo at 18 weeks. However, this advantage didn't persist at 24 weeks, coinciding with the expected diminishing effects of the injection. Additionally, the treatment was associated with some adverse events.


ClinicalTrials.gov number, NCT02555982. 

Access the original article

Marques, A., Pereira, B., Simonetta-Moreau, M., Castelnovo, G., De Verdal, M., Fluchère, F., Laurencin, C., Degos, B., Tir, M., Kreisler, A., Blanchet-Fourcade, G., Guehl, D., Colin, O., Poujois, A., Sangla, S., Tatu, L., Derost, P., Gayraud, D., Tranchant, C., Amarantini, D., … Btx-HT Study Group (2023). Trial of Botulinum Toxin for Isolated or Essential Head Tremor. The New England journal of medicine, 389(19), 1753–1765. https://doi.org/10.1056/NEJMoa2304192

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