Botulinum Neurotoxin A for Hand Tremors in Parkinson’s Disease: A Meta-Analytic Study


Background: Resting tremor is a prominent cardinal motor symptom of Parkinson’s disease (PD). In some cases, the tremor may be refractory to dopaminergic and anticholinergic treatment. Multiple studies were previously done to evaluate the effectiveness of Botulinum Neurotoxin A (BoNT/A) with essential tremors and dystonia, but data regarding its use on tremors of PD is still lacking.

Objective: This meta-analytic study aims to determine the effectiveness of BoNT/A in treating tremors of patients with PD.

Data Sources: Researches were searched at PubMed, ScienceDirect and EBSCO Host.

Review Methods: Articles on the effect of BoNT/A on PD hand tremors were searched. Studies and data pertaining to non-PD tremors like essential tremors excluded in the analysis due to difference in pathophysiology. Standardized mean difference was used as the effect measure and was computed with Review Manager version 5.4 software.

Results: Three open label studies were used for final analysis in this study. Studies included are those pertaining to tremors due to PD. Pooled estimates showed a significant change in decreasing tremor score after BoNT/A injection.

Conclusion: Botulinum Toxin A injections can be used to manage PD tremors effectively.

Keywords: Botulinum neurotoxin A, Botox A, Btx, tremors, Parkinson’s disease


  1. Mittal SO, Machado D, Richardson D, Dubey D, Jabbari B. Botulinum toxin in Parkinson disease tremor: A randomized, double-blind, placebo-controlled study with a customized injection approach. Mayo Clin Proc. 2017;92(9):1359–67. Available from:
  2. Mills R, Bahroo L, Pagan F. An update on the use of botulinum toxin therapy in Parkinson’s disease. Curr Neurol Neurosci Rep. 2015;15(1):511. Available from:
  3. Cardoso F. Botulinum Toxic in Parkinsonism: The when, how and which for botulinum toxin injections. Toxicon. 2017 147:107–10.
  4. Rahimi F, Bee C, Debicki D, Roberts AC, Bapat P, Jog M. Effectiveness of BoNT A in Parkinson’s disease upper limb tremor management. Can J Neurol Sci. 2013;40(5):663–9. Available from:
  5. Rahimi F, Samotus O, Lee J, Jog M. Effective management of upper limb Parkinsonian tremor by incobotulinum toxina injections using sensor-based biomechanical patterns. Tremor and Other Hyperkinetic Movements. 2015;5:348
  6. Samotus O, Lee J, Jog M. Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections. PLoS One. 2017;12(6):e0178670. Available from:
  7. Niemann N, Jankovic J. Botulinum toxin for the treatment of hand tremor. Toxins (Basel). 2018;10(7):299. Available from:
  8. Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol. 2012;15(3):325–36. Available from:
  9. Wheeler A, Smith HS. Botulinum toxins: mechanisms of action, antinociception and clinical applications. Toxicology. 2013;306:124–46. Available from:
  10. Zakin E, Simpson D. Botulinum toxin in management of limb tremor. Toxins(Basel). 2017;9(11):365. Available from:
  11. Melnyk, B. M., & Fineout-Overholt, E. Evidence-based practice in nursing & healthcare. Philadelphia, PA: Lippincott Williams & Wilkins. 2005; 6-10.
  12. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. Available from:
  13. Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Toxicon. 2018;147:84–8. Available from:

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit