Send to

Choose Destination
J Neurol Neurosurg Psychiatry. 2014 Jul;85(7):759-69. doi: 10.1136/jnnp-2013-305532. Epub 2013 Oct 28.

The treatment of dystonic tremor: a systematic review.

Author information

Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Department of Neurology, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy.
Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada Department of Neurology, The Edmond J. Safra Program in Parkinson's Disease, Toronto, Ontario, Canada.


Tremor is one of the clinical manifestations of dystonia; however, there are no specific therapeutic trials evaluating the efficacy of treatments for dystonic tremor (DT), tremor associated with dystonia or primary writing tremor (PWT). We systematically reviewed the literature available up to July 2013 on the treatment of these tremors and retrieved the data of 487 patients published in 43 papers detailing the effects of given interventions on tremor severity. Treatment outcome was highly variable, depending on the specific type of intervention and tremor distribution. No specifically designed studies were available for the treatment of tremor associated with dystonia. As for the other tremors, drug efficacy was generally disappointing and a moderate effect was only found with anticholinergics, tetrabenazine, clonazepam, β-blockers and primidone; levodopa was only efficacious on tremor due to dopa-responsive dystonia. The largest amount of data was available for botulinum toxin injections, which provided a marked improvement, particularly for the management of axial tremors (head or vocal cords). In refractory DTs, deep brain stimulation of several targets was attempted. Deep brain stimulation of globus pallidus internus, thalamus or subthalamic area led to a marked improvement of dystonic axial or appendicular tremors in most cases refractory to other treatments. Few other non-invasive treatments, for example, orthotic device in PWT, have been used with anecdotal success. In conclusion, considering the lack of good-quality studies, future randomised controlled trials are needed. In absence of evidence-based guidelines, we propose an algorithm for the treatment of DT based on currently available data.


Botulinum Toxin; Dystonia; Neuropharmacology; Neurosurgery; Tremor

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center