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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Dec;75(12):1688–1691. doi: 10.1136/jnnp.2003.032227

Factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin

R Djebbari 1, S T du Montcel 1, S Sangla 1, J Vidal 1, G Gallouedec 1, M Vidailhet 1
PMCID: PMC1738875  PMID: 15548483

Abstract

Objective: To identify factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin (BTX).

Methods: 47 patients with writer's cramp were treated with BTX and were evaluated by the same neurologists at initial referral, after each BTX injection, and when the effect of BTX was maximal at the time of the study. Patients and examiners simultaneously and independently rated the efficacy of BTX injections. Self assessment was a global clinical impression of the impact of treatment on writing quality, writing speed, writing errors, and legibility of handwriting; for objective assessment, the examiners used the Burke-Fahn-Marsden (BFM) scale.

Results: On the BFM scale, there was a significant improvement (p<0.0001) in both severity and disability scores. Patients with a pronation/flexion pattern of dystonia showed the best and the most sustained improvement. Primary writing tremor was little improved. There was a correlation between the self assessment score and the Burke-Fahn-Marsden score. Benefit was maintained over time

Conclusions: These results have implications for the identification of patients most likely to benefit from BTX injections.

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Selected References

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  1. Brin M. F., Lyons K. E., Doucette J., Adler C. H., Caviness J. N., Comella C. L., Dubinsky R. M., Friedman J. H., Manyam B. V., Matsumoto J. Y. A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology. 2001 Jun 12;56(11):1523–1528. doi: 10.1212/wnl.56.11.1523. [DOI] [PubMed] [Google Scholar]
  2. Burke R. E., Fahn S., Marsden C. D., Bressman S. B., Moskowitz C., Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology. 1985 Jan;35(1):73–77. doi: 10.1212/wnl.35.1.73. [DOI] [PubMed] [Google Scholar]
  3. Byrnes M. L., Thickbroom G. W., Wilson S. A., Sacco P., Shipman J. M., Stell R., Mastaglia F. L. The corticomotor representation of upper limb muscles in writer's cramp and changes following botulinum toxin injection. Brain. 1998 May;121(Pt 5):977–988. doi: 10.1093/brain/121.5.977. [DOI] [PubMed] [Google Scholar]
  4. Cohen L. G., Hallett M., Geller B. D., Hochberg F. Treatment of focal dystonias of the hand with botulinum toxin injections. J Neurol Neurosurg Psychiatry. 1989 Mar;52(3):355–363. doi: 10.1136/jnnp.52.3.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cohen L. G., Hallett M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. 1988 Jul;38(7):1005–1012. doi: 10.1212/wnl.38.7.1005. [DOI] [PubMed] [Google Scholar]
  6. Cole R., Hallett M., Cohen L. G. Double-blind trial of botulinum toxin for treatment of focal hand dystonia. Mov Disord. 1995 Jul;10(4):466–471. doi: 10.1002/mds.870100411. [DOI] [PubMed] [Google Scholar]
  7. Hsiung G-Y R., Das S. K., Ranawaya R., Lafontaine A-L, Suchowersky O. Long-term efficacy of botulinum toxin A in treatment of various movement disorders over a 10-year period. Mov Disord. 2002 Nov;17(6):1288–1293. doi: 10.1002/mds.10252. [DOI] [PubMed] [Google Scholar]
  8. Jankovic J., Schwartz K. S. Use of botulinum toxin in the treatment of hand dystonia. J Hand Surg Am. 1993 Sep;18(5):883–887. doi: 10.1016/0363-5023(93)90060-G. [DOI] [PubMed] [Google Scholar]
  9. Karp B. I., Cole R. A., Cohen L. G., Grill S., Lou J. S., Hallett M. Long-term botulinum toxin treatment of focal hand dystonia. Neurology. 1994 Jan;44(1):70–76. doi: 10.1212/wnl.44.1.70. [DOI] [PubMed] [Google Scholar]
  10. Meunier Sabine, Lehéricy Stéphane, Garnero Line, Vidailhet Marie. Dystonia: lessons from brain mapping. Neuroscientist. 2003 Feb;9(1):76–81. doi: 10.1177/1073858402239593. [DOI] [PubMed] [Google Scholar]
  11. Molloy F. M., Shill H. A., Kaelin-Lang A., Karp B. I. Accuracy of muscle localization without EMG: implications for treatment of limb dystonia. Neurology. 2002 Mar 12;58(5):805–807. doi: 10.1212/wnl.58.5.805. [DOI] [PubMed] [Google Scholar]
  12. Rivest J., Lees A. J., Marsden C. D. Writer's cramp: treatment with botulinum toxin injections. Mov Disord. 1991;6(1):55–59. doi: 10.1002/mds.870060110. [DOI] [PubMed] [Google Scholar]
  13. Sheehy M. P., Rothwell J. C., Marsden C. D. Writer's cramp. Adv Neurol. 1988;50:457–472. [PubMed] [Google Scholar]
  14. Tsui J. K., Bhatt M., Calne S., Calne D. B. Botulinum toxin in the treatment of writer's cramp: a double-blind study. Neurology. 1993 Jan;43(1):183–185. doi: 10.1212/wnl.43.1_part_1.183. [DOI] [PubMed] [Google Scholar]
  15. Turjanski N., Pirtosek Z., Quirk J., Anderson T. J., Rivest J., Marsden C. D., Lees A. J. Botulinum toxin in the treatment of writer's cramp. Clin Neuropharmacol. 1996 Aug;19(4):314–320. doi: 10.1097/00002826-199619040-00004. [DOI] [PubMed] [Google Scholar]
  16. Wissel J., Kabus C., Wenzel R., Klepsch S., Schwarz U., Nebe A., Schelosky L., Scholz U., Poewe W. Botulinum toxin in writer's cramp: objective response evaluation in 31 patients. J Neurol Neurosurg Psychiatry. 1996 Aug;61(2):172–175. doi: 10.1136/jnnp.61.2.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Yoshimura D. M., Aminoff M. J., Olney R. K. Botulinum toxin therapy for limb dystonias. Neurology. 1992 Mar;42(3 Pt 1):627–630. doi: 10.1212/wnl.42.3.627. [DOI] [PubMed] [Google Scholar]

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