ABSTRACT
INTRODUCTION: Writer's cramp is a focal dystonia; treatment remains disappointing. We report our 14-year experience with a population of 119 patients aged between 18 and 85 years (average age 43 years). METHODS: Treatment was based on botulinum toxin injections (Dysport) and physiotherapy. Patients were reviewed every four to six months with clinical and video evaluation by three different observers and subjective analysis of the treatment efficiency by the patient (score of 1 to 3). The post-injection deficit, if present, was also quantified. RESULTS: In the group treated with toxin and physiotherapy, cramps improved (score 2 and 3) in 61.6% of patients; a majority of patients (n=14) reported they were moderately satisfied (score 2). In the group treated with toxin alone, 37.9% of patients were improved (score 2 and 3) with a majority (n=18) very satisfied reporting normal writing (score 3). Age was not a predictor of therapeutic response. Good results were obtained with injections of the flexor carpi radialis followed by flexor digitorum profundus II and III and the flexor pollicis longus. Seventy-one per cent of injections caused moderate muscle weakness, minimally disabling compared to the benefit of injections. Twenty-seven patients were followed for more than two years and three patients, who had achieved score 3 with excellent response, were followed for 14 years with very efficient repeated injections. If the injections were not effective the first time, we re-assessed the situation and adjusted the injections; we considered that toxin treatment was unsuccessful after three injections without benefit. CONCLUSION: The choice treatment for writer's cramp remains well-targeted injections of botulinum toxin. Physiotherapy is useful when the toxin injections are ineffective in completely improving writing. This requires close cooperation between the injector, the physiotherapist and the patient.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Dystonic Disorders/drug therapy , Neuromuscular Agents/therapeutic use , Adult , Botulinum Toxins, Type A/administration & dosage , Combined Modality Therapy , Dystonic Disorders/therapy , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Neuromuscular Agents/administration & dosage , Physical Therapy ModalitiesABSTRACT
OBJECTIVES: The aim of the study was to evaluate the incidence and the risk factors of heterotopic ossifications in patients with severe traumatic brain injury. MATERIAL AND METHODS: This retrospective study was conducted in a sample of 86 patients during a two years period. These patients were receiving care in an acute rehabilitation setting designed for traumatic brain injury patients emerging from coma. The statistical analysis used chi(2) and Fisher tests. RESULTS, DISCUSSION: Forty-nine heterotopic ossifications were observed in 24 patients (incidence 28.57%, 2.04/patient). Most of them were localised at the level of the hip, of the elbow and of the knee. No significant relation was found between heterotopic ossification and sex, age, clinical severity, motor impairment, spasticity or autonomic dysreflexia. On the contrary, associated limb fractures, specially when requiring a surgical treatment, were found to be correlated to a greater incidence of heterotopic ossification. CONCLUSION: Some of the risk factors observed in the present study were in accordance with those previously described in the literature. This work shows the difficult place of the initial care of patients with severe traumatic brain injury specially during there stay in intensive care units.
