Effectiveness of treatments for dystonic tremor: a systematic review.

Abstract

Introduction: Dystonic Tremor is a type of tremor of action that appears in the segment affected by dystonia. Its treatment includes pharmacological and invasive strategies, however there is insufficient evidence for clinical decision-making. Objective: To review the currently published evidence on the efficacy and safety of pharmacological and/or surgical treatment to treat dystonic tremor of any degree of severity. Methodology: This was a systematic review conducted in the electronic databases Medline (via PubMed), Embase, Cochrane Library, Web of Science, and Scopus (from inception to January 30, 2024). Two independent reviewers performed the selection, data extraction, and risk of bias assessment. Risk of bias assessment was performed using the "Risk of Bias Tool for Randomized Trials," "Risk of Bias in Non-Randomized Studies of Interventions," and the Modified Newcastle Ottawa Scale for Observational Studies. Furthermore, the quality of evidence certainty was assessed using the “Grading of Recommendations Assessment, Development and Evaluation”. Results: Thirty-six studies were included, 11 case reports and cohort studies each, nine case series and five clinical trials, totaling 512 participants. Among the interventions described were pharmacological treatments, transcranial stimulation, and invasive procedures. Conclusion: Among the interventions identified, it was observed that 63.8% presented reports of Deep Brain Stimulation in which a probable therapeutic benefit was observed in reducing the severity of the tremor. The main adverse effects of Deep Brain Stimulation are dysarthria, gait instability or ataxia, and paresthesia.