Rajan R, Srivastava AK, Anandapadmanabhan R, et al. - In patients with upper-extremity dystonic tremor (DT), researchers sought to evaluate the impact of botulinum neurotoxin (BoNT) injections on tremor in this placebo-controlled, parallel-group randomized clinical trial involving 30 patients (mean [SD] age, 46.0 [18.6] years; 26 [86.7%] male). Using a computer-generated randomization sequence, study participants were allocated in a 1:1 ratio to BoNT or saline injection, 0.9%. Electromyographically directed intramuscular injections of BoNT or placebo were given into the tremulous muscles of the upper extremity. According to tremor phenomenologic findings, injection patterns and doses were individualized. Electromyographically guided individualized BoNT injections were beneficial for achieving tremor control without unacceptable hand weakness in patients with upper-extremity DT. BoNT injections were found to be more effective than placebo in reducing tremor severity in upper-extremity DT. Individualized muscle selection and dosing proved effective without causing unacceptable adverse effects.