What is it?

Writer’s cramp is a task-specific focal dystonia of the hand. Symptoms… What is it?

Writer’s cramp is a task-specific focal dystonia of the hand. Symptoms usually appear when a person is trying to do a task that requires fine motor movements. The symptoms may appear only during a particular type of movement, such as writing or playing the piano, but the dystonia may spread to affect many tasks.

Two types of writer’s cramp have been described: simple and dystonic. People with simple writer’s cramp have difficulty with only one specific task. For example, if writing activates the dystonia, as soon as the person picks up a pen or within writing a few words, dystonic postures of the hand begin to impede the speed and accuracy of writing. In dystonic writer’s cramp, symptoms will be present not only when the person is writing, but also when performing other task-specific activities, such as shaving, using eating utensils or applying makeup.

What are the symptoms?

Common manifestations of simple writer’s cramp include excessive gripping of the pen, flexion, and sometimes deviation of the wrist, elevation of the elbow and occasional extension of a finger or fingers, causing the pen to fall from the hand. Sometimes the disorder progresses to include the elevation of shoulders or the retraction of arm while writing. Tremor is usually not a symptom of writer’s cramp. The symptoms usually begin between the ages of 30 and 50 years old and affect both men and women.

What causes it?

Writer’s cramp is believed to be due to abnormal functioning of the basal ganglia, which are deep brain structures involved with the control of movement. The basal ganglia assists in initiating and regulating movement. What goes wrong in the basal ganglia is still unknown. An imbalance of dopamine, a neurotransmitter in the basal ganglia, may underlie several different forms of dystonia, but much more research needs to be done for a better understanding of the brain mechanisms involved with the disease.

Cases of inherited writer’s cramp have been reported, usually in conjunction with early-onset generalized dystonia, which is associated with the DYT1 gene.

What treatments are available?

Treatment for dystonia is designed to help lessen the symptoms of spasms, pain and disturbed postures and functions. Most therapies are symptomatic, attempting to cover up or release the dystonic spasms. No single strategy will be appropriate for every case.

The approach for treatment of dystonia is usually three-tiered: oral medications, botulinum toxin injections and surgery. These therapies may be used alone or in combination. Complementary care, such as physical therapy and speech therapy, may also have a role in the treatment management depending on the form of dystonia. For many people, supportive therapy provides an important adjunct to medical treatment.

Although there is currently no known cure for dystonia, we are gaining a better understanding of dystonia through research and are developing new approaches to treatments.

This information is courtesy of Dystonia Medical Research Foundation.