Writer's cramp is a type of focal dystonia that is specific to the task (Dystonia is an involuntary, sustained muscle contraction) Writer's cramp is the commonest dystonia of the repetitive movement disorders. Cerebellar abnormalities have been detected but it is not known whether these are the cause or the effect of writer's cramp.Management
-Reducing the amount of writing that is done is basic to an overuse syndrome Use of a keyboard instead of a pen may help.
There may be some benefit from using a wider pen or an attachment to make it wider.
-Hand writing training produces improvement but does not bring return to normality. Using a modified pen grip is sometimes beneficial.
-Psychological treatment such as habit reversal seems no better than relaxation exercises. -Historically there has been a tendency to classify the condition as a neurosis but the evidence points to a physical aetiology.
-Transcutaneous electrical nerve stimulation (TENS) gives better results than placebo.
-A number of drugs, especially anticholinergics and L dopa, have been used with little benefit but botulinum toxin injection seems the most effective. Patients who are most likely to benefit can be identified.
-In exceptional cases stereotactic nucleus ventrooralis thalamotomy may be of value.
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