Treatment of Dystonic Writers’ Cramp
Dystonic writers’ cramp is a form of task-specific, focal dystonia. It is most commonly seen as part of an idiopathic focal, segmental or generalised isolated dystonia syndrome but can also occur as part of either isolated or combined or inherited or acquired dystonia. The treatment of choice is botulinum toxin injections, but the response rate is lower than with other forms of focal dystonia such as cervical dystonia or blepharospasm. Oral medications are usually ineffective. In botulinum toxin-resistant cases, there is some evidence to support the use of motor or sensory retraining or, in exceptional circumstances, functional neurosurgery.
KeywordsDystonia Writers’ cramp Upper limb dystonia Task-specific dystonia
Segment 1 shows the patient Dystonic writers’ cramp patient history before treatment. Note the intermittent flexion of the thumb leading to the thumb slipping off the pen and interruption of the flow of writing with intermittent exaggerated lifting of the pen tip from the page. There is mirror dystonia with the right thumb tending to flex when he writes with his left hand. Segment 2 is taken after 18 months of botulinum toxin therapy. The patient can now write smoothly and quickly with the thumb staying on the pen, although he uses a slightly modified pen grip (MP4 17637 kb)
- Marion MH, Afors K, Sheehy MP. Problems of treating writers’ cramp with botulinum toxin injections: results from 10 years of experience. Rev Neurol (Paris). 2003;159:923–7.Google Scholar