Dystonic tremor, such as writer’s cramp, may be a debilitating condition often missed by non-neurology physicians, and even neurologists. Importantly, dystonic tremors may be misdiagnosed leading to unnecessary investigations and delay in effective therapies. In this issue of JNNP, Langs group from Toronto write a superb review on this subject. The review focuses on therapies for dystonic tremor, encompassing pharmaceutical (oral drugs), toxin and surgical approaches. The review highlights important therapies, emphasising the role of botulinum toxin, and provides an nice algorithm for treatment (see below).