Botulinum toxin for essential tremor.

Essential tremor is one of the most common causes of action tremors, involving bilateral upper limbs, with or without tremor in other body regions such as the head, voice, or lower limbs. Pharmacotherapy is the first-line treatment for essential limb tremor; however, a significant number of patients fail to achieve adequate improvement with medical management. Therapeutic options, such as deep brain stimulation, lesioning surgeries, or magnetic resonance-guided focused ultrasound, are more invasive and carry inherent risks. Thus, botulinum toxin serves as an important alternative for managing medically resistant essential limb tremors and is considered clinically useful. Axial symptoms of essential tremor such as head or voice tremors rarely respond to medical management, making botulinum toxin a key therapeutic option in their management, despite safety concerns of weakness. This review aims to explore these considerations by examining existing literature on the application of botulinum toxin for essential limb, head, and voice tremors.