Treatment of writer's cramps with botulinum toxim

ABSTRACT

Treatment of writer's cramp is quite disappointing. Botulinum toxin A [BTX] is emerging as the first line of treatment of writer's cramp. We evaluate the effect of BTX in 12 patients of writer's cramp. Patients and Method: Twelve patients of writer's cramp [11 men, one woman], with mean age of 33.92 years and mean duration of symptoms for 3.3 years, received 17 treatment sessions of BTX. Each patient was evaluated before and 3 and 12 weeks after BTX therapy on a rating scale for speed of writing, ease of writing, abnormal posture and pain. Each patient also gave a global subjective assessment 12 weeks after BTX therapy. Result: Follow-up was available in 13 treatment sessions. Significant improvement occurred in speed of writing [p=0.0025], ease of writing [p=0.0025], abnormal posture [p=0.0039] and pain [p=0.0092]. An improvement of 50% or more was observed after nine BTX therapy sessions whereas less than 50% improvement was observed after four treatment sessions. All patients developed mild asymptomatic weakness in limb muscles. Only three patients complained of any weakness. The mean onset of improvement was 8.79 days and duration of effect 8.0 weeks. BTX is an effective treatment of writer's cramp. Improvement of patient's hand writing is not a good indicator of patients satisfaction and relief of symptom. EMG guided BTX injection should be restricted for deep muscles. Frequent repeated infections of BTX should be avoided