Botox is a brand-name injectable botulinum toxin (BoNT) that your doctor may prescribe off-label for essential tremor (ET). The drug isn’t approved for this use, but it has been shown to be helpful in treating ET.
The Food and Drug Administration (FDA) has approved Botox (onabotulinumtoxinA) to treat several conditions, including migraine and overactive bladder. In some cases, your doctor may prescribe Botox off-label to treat ET. Off-label drug use is when an FDA-approved drug is prescribed for a purpose other than what it’s approved for.
Read on for more information about Botox for ET. To learn about the approved medical uses of Botox, you can refer to this article. Note that Botox Cosmetic is a different version of Botox that’s prescribed for other uses.
Botox has a boxed warning. A boxed warning is the most serious warning from the FDA. For details, see “Before receiving Botox.”
According to a
In a 2023 study involving 117 people who were experiencing head tremor (not due to PD), participants received 2 injections of either Botox or a placebo (with no active ingredient) 12 weeks apart. Six weeks after the second injection, more of the people who received Botox injections reported an improvement in symptoms.
Who Botox is prescribed for
The FDA has not approved Botox to treat ET. However, doctors may prescribe the drug off-label for ET. The American Academy of Neurology (AAN) practice guidelines state that BoNT may be used for ET that doesn’t respond to standard treatment.
ET is a common movement disorder that causes rhythmic, uncontrollable shaking of a part of your body. The tremors are caused by muscle contractions. ET most commonly involves the upper limbs (arms and hands), head, and voice. The condition typically gets worse with time but may remain mild.
Researchers don’t know the exact cause of ET, but it may involve a part of your brain called the cerebellum. The National Institute of Neurological Disorders and Stroke reports that ET is inherited in
Tremors can also be due to other movement conditions, including certain dystonias and PD. In fact, Botox is FDA-approved to treat cervical dystonia, which affects the neck.
Essential tremor medications and other treatment options
The first-line treatment for ET is oral medication. Specifically, the latest ET treatment guideline from the AAN recommends a course of the beta-blocker propranolol (Inderal LA) or the antiseizure drug primidone (Mysoline).
Second-line treatments for ET include other antiseizure drugs as well as benzodiazepines and antipsychotics. Your doctor may also combine certain medications, such as propranolol and primidone.
However,
When medication doesn’t help, doctors may use surgical procedures to help manage ET. Possible procedures include deep brain stimulation (DBS) and focused ultrasound. You can learn more about DBS and other surgeries for tremors due to PD.
If you have ET, talk with your doctor about all your treatment options. They can help determine which treatment(s) may best meet your needs.
Botox treats ET in the same way it treats other conditions — by blocking nerve signals in the injection area. Since your muscles contract only when they receive nerve signals, Botox helps prevent your muscles from moving.
The effects of Botox are local and temporary. Only the muscles in the injection area are affected. Once the toxin wears off, the nerves begin signaling again and your symptoms usually return.
How long does Botox last for tremors?
Studies show that Botox may improve tremors within
If you’re interested in Botox, ask your doctor what to expect with treatment for ET.
Botox is given by injection into certain muscles. The specific location(s) depend on the severity and location of your tremors.
For example, you’ll receive Botox injections in your forearm muscles to help manage hand tremors. If you’re receiving Botox for head tremors, your doctor will inject the drug into the deep muscle on each side of your neck. Your doctor may use a combination of techniques to choose the exact location of the injection(s).
Since Botox isn’t approved to treat ET, the drug’s prescribing information doesn’t provide recommended dosages. In the clinical trial of Botox for head tremors, 2 Botox treatments were given 12 weeks apart. Your doctor will determine the Botox dosage and injection frequency that’s right for you.
Like other drugs, Botox for tremors can cause side effects, including:
- head and neck pain
- muscle weakness in the treatment area, including the back of your neck
- difficulty swallowing
Other side effects that have been reported with Botox vary, depending on the treatment area.
Before your doctor prescribes Botox off-label for ET, there’s some important information to consider. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.
Boxed warning: Spread of toxin effects
Botox has a boxed warning about the risk of the spread of toxin effects. A boxed warning is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.
Botox is a neurotoxin derived from Clostridium botulinum, the bacterium that causes botulism. It’s possible for Botox to spread beyond the injection site. This can cause the same types of life threatening symptoms seen with botulism, including difficulty swallowing and difficulty breathing. Toxin spread did not occur in clinical trials, but there have been rare reports since the drug was approved. The toxin can spread hours to weeks after injection.
If you experience the above or other unusual symptoms any time after receiving Botox treatment, call your doctor right away. If your symptoms feel life threatening, call 911 or your local emergency number.
Other warnings
Before receiving Botox, talk with your doctor if either of the following factors is relevant to you:
- an allergic reaction to this or a similar drug
- infection at the treatment site(s)
Botox may be prescribed off-label for ET, including hand and head tremors. In clinical trials and other studies, Botox injections into target muscles were shown to be effective for some people. Symptoms improved within 6 weeks of treatment, and improvements lasted several months.
As with the drug’s other uses, using Botox for ET can cause side effects, including difficulty swallowing and muscle weakness.
Before receiving Botox, talk with your doctor about its potential benefits and risks for treating your condition.