P-MD018. Diagnostic approach for idiopathic simple writer’s cramp: A rare case of neurofunctional disorder

Abstract

Introduction . Writer’s cramp is a part of focal hand dystonia that occurs task specifically during writing. It may happen in a person with the habit to write rapidly, continuously, and combined with individual vulnerability. This condition is highly disabling, accompanied by pain, and significantly decreases functional activity. Not only professionally disturbing, but this condition also leads to emotional and social problems for the patient. Results . We present here an unusual case of a 25-year-old right-handed woman with complaint of difficulty in writing since one year ago. She complained of involuntary muscle contraction in her upper right extremity, an extension of the finger, deviation of the wrist and elbow, followed by pain that happened only when she was writing. The symptoms progressed, and she was unable to write even a few words. Neurological examination revealed no abnormality. A series of laboratory tests, neurophysiology examinations, and brain MRI was performed. Diagnosis was suggestive of idiopathic simple writer’s cramp. Botulinum toxin was injected to the affected muscle. We also performed neuromuscular electrical stimulation as a neuro-rehabilitation therapy. The handwriting performance was examined and compared before and after treatment. The response to treatment was good, and the patient could write better with reduced tension in her right hand after treatment. Conclusion . Diagnosis writer’s cramp requires careful observation of the movements and motor control. Identifying patient properly can be of great first step to overcome this condition. Several diagnostic processes should perform to make an accurate diagnosis and appropriate treatment. Keywords: Writer’s Cramp, Focal Dystonia, Diagnostic Approach.