Bellows Steven, Jankovic Joseph
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Toxins (Basel). 2025 Aug 11;17(8):401. doi: 10.3390/toxins17080401.
Tremor, an oscillatory movement disorder, is commonly encountered in clinical practice in the setting of a variety of etiologies, such as essential tremor and Parkinson's disease. Despite its high prevalence, treatment options are somewhat limited. Oral medications are often ineffective or limited by side effects, and other treatments, such as deep brain stimulation, are more invasive and costly. Botulinum toxin (BoNT) injections are a well-established therapy in the treatment of dystonia, but its use in the treatment of tremors has not been fully explored. In this review, we discuss the available randomized controlled trials and open-label evidence for the use of BoNT in various tremor etiologies, as well as its injection techniques. While essential tremor is the most studied condition, other tremor etiologies and tremor types such as Parkinson's disease, head tremor, voice tremor, proximal tremor, and tremor due to dystonia and multiple sclerosis have been studied as well. Botulinum toxin injections have provided evidence of significant benefit in outcomes in several trials among these indications, but transient weakness remains a common adverse effect. There is a paucity of well-designed trials as many published studies have relatively small cohorts and results are additionally limited by heterogenous outcome measures, dosages, muscle selection techniques and methods of injection.
震颤是一种振荡性运动障碍，在临床实践中，在多种病因（如特发性震颤和帕金森病）的情况下很常见。尽管其患病率很高，但治疗选择在一定程度上受到限制。口服药物往往无效或受副作用限制，而其他治疗方法，如深部脑刺激，更具侵入性且成本更高。肉毒杆菌毒素（BoNT）注射是治疗肌张力障碍的一种成熟疗法，但其在震颤治疗中的应用尚未得到充分探索。在本综述中，我们讨论了使用BoNT治疗各种震颤病因的现有随机对照试验和开放标签证据，以及其注射技术。虽然特发性震颤是研究最多的疾病，但其他震颤病因和震颤类型，如帕金森病、头部震颤、声音震颤、近端震颤以及由肌张力障碍和多发性硬化引起的震颤也已得到研究。肉毒杆菌毒素注射在这些适应症的多项试验中已证明对结果有显著益处，但短暂性无力仍然是常见的不良反应。由于许多已发表的研究队列相对较小，且结果还受到异质性结局测量、剂量、肌肉选择技术和注射方法的限制，因此缺乏设计良好的试验。
