Skip to main content Accessibility help
×
Home
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2009
  • Online publication date: July 2009

9 - Treatment of focal hand dystonia

Summary

Definition

Dystonic contractions are often aggravated by purposeful actions and may be specific to a particular task. A patient may have dystonia when using the hand for writing but not for other tasks such as eating or typing. Occupational dystonias are those that occur in individuals with a particular occupation requiring repetitive and excessive fine motor activity. Most of these dystonias are task specific and fall under the rubric of primary focal dystonias. The occupations especially prone to have focal task-specific dystonia are listed inTable 9.1.

In this chapter we discuss in detail writer's cramp and musician's cramp, the two most common occupational dystonias, followed by a brief mention of other focal occupational dystonias.

Pathogenesis

Although the exact cause of these focal dystonias is not yet elucidated, it seems that an interaction of proprioceptive, behavioral, genetic, gestural, environmental, and psychological factors plays a role. Excessive activation of antagonists, overflow into synergists, and prolongation of muscle activation are thought to reflect deficiency of premotor cortical network inhibition (Hallett, 2000, 2006a, b). Decreased levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) are present in the contralateral sensorimotor cortex and lentiform nucleus in patients with writer's cramp (Levy & Hallett, 2002). Functional magnetic resonance imaging shows impaired activation of the primary sensorimotor and supplementary motor cortex during voluntary muscle relaxation and contraction (Oga et al., 2002). A genetic factor in the development of hand dystonia is possible, as up to 20% of patients with writer's cramp have family members with dystonia.

REFERENCES
Candia, V., Schafer, T., Taub, E., et al. (2002). Sensory motor retuning: a behavioral treatment for focal hand dystonia of pianists and guitarists. Arch Phys Med Rehabil, 83, 1342–8.
Chamagne, P. (2003). Functional dystonia in musicians: rehabilitation. Hand Clinics, 19, 309–16.
Cohen, L. G., Hallett, M., Geller, B. D. & Hochberg, F. (1989). Treatment of focal dystonias of the hand with botulinum toxin injections. J Neurol Neurosurg Psychiatry, 52, 355–63.
Cole, R. A., Cohen, L. G. & Hallett, M. (1991). Treatment of musician's cramp with botulinum toxin. Med Probl Perform Artists, 6, 137–43.
Das, S. K., Banerjee, T. K., Biswas, A., et al. (2007). Community survey of primary dystonia in the city of Kolkata, India. Mov Disord, 22, 2031–6.
Djebbari, R., Dumontcel, S. T., Sangla, S., et al. (2004). Factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin. J Neurol Neurosurg Psychiatry, 75, 1688–91.
Duffey, O., Butler, A. G., Hawthorne, M. R. & Barnes, M. P. (1998). The epidemiology of the primary dystonias in the north of England. Adv Neurol, 78, 12–15.
,Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. (1999). Sex related influences on the frequency and age of onset of primary dystonia. Neurology, 53, 1871–3.
,Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. (2000). A prevalence study of primary dystonia in eight European countries. J Neurol, 247, 787–92.
Hallett, M. (1998). Physiology of dystonia. Adv Neurol, 78, 11–18.
Hallett, M. (2000). Disorder of movement preparation in dystonia. Brain, 123, 1765–6.
Hallett, M. (2006a). Pathophysiology of dystonia. Journal of Neural Transmission Suppl. 70, 485–8.
Hallett, M. (2006b). Pathophysiology of writer's cramp. Hum Mov Sci, 4–5, 454–63.
Hsuing, G. Y., Das, S. K. & Ranawaya, R. (2002). Long term efficacy of botulinum toxin A in treatment of various movement disorders over a 10 year period. Mov Disord, 17, 1288–93.
Jedynak, P. C., Tranchant, C. & Zegers Debeyl, D. (2001). Prospective clinical study of writer's cramp. Mov Disord, 16, 494–9.
Karp, B. I. (2004). Botulinum toxin treatment of occupational and focal hand dystonia. Mov Disord, 19(Suppl 8), S116–19.
Karp, B. I., Cole, R. A., Cohen, L. G., et al. (1994). Long term botulinum toxin treatment of focal hand dystonia. Neurology, 44, 70–6.
Lee, H. & DeLisa, J. (2000). Surface Anatomy for Clinical Needle Electromyography. New York, NY: Demos Medical Publishing.
Levy, L. M. & Hallett, M. (2002). Impaired brain GABA in focal dystonia. Ann Neurol, 51, 93–101.
McDaniel, K. D., Cummings, J. L. & Shain, S. (1989). The “yips”: a focal dystonia of golfers. Neurology, 39, 192–5.
Molloy, F. M., Shill, H. A., Kaelin–Lang, A. & Karp, B. I. (2002). Accuracy of muscle localization without EMG: implications for treatment of limb dystonia. Neurology, 58, 805–7.
Newmark, J. & Hochberg, F. H. (1987). Isolated painless manual incoordination in 57 musicians. J Neurol Neurosurg Psychiatry, 50, 291–5.
Nutt, J. G., Muenter, M. D., Aronson, A., Kurland, L. T. & Melton, L. J. (1988). Epidemiology of focal and generalised dystonia in Rochester Minnesota. Mov Disord, 3, 188–94.
Oga, T., Honda, M., Toma, K., et al. (2002). Abnormal cortical mechanisms of voluntary muscle relaxation in patients with writer's cramp: an MRI study. Brain, 125, 895–903.
Singer, , C., Papapetropoulos, S. & Vela, L. (2005). Use of mirror dystonia as guidance for injection of botulinum toxin in writing dysfunction. J Neurol Neurosurg Psychiatry, 76, 1608–9.
Soland, V. L., Bhatis, K. P. & Marsden, C. D. (1996). Sex prevalence of focal dystonias. J Neurol Neurosurg Psychiatry, 60, 204–5.
Solly, S. (1864). Scrivener's palsy, or paralysis of writer's. Lancet, 2, 709–11.
Taira, T., Harashima, S. & Hori, T. (2003). Neurosurgical treatment for writer's cramp. Acta Neurochir, 87(Suppl), 129–31.
Tsui, J. K. C., Bhatt, M., Calne, S. & Calne, D. B. (1993). Botulinum toxin in the treatment of writer's cramp. A double blind study. Neurology, 43, 183–5.
Tubiana, R. (2003). Musician's focal dystonia. Hand Clinics, 19, 303–8.
Turjanski, N., Pirtosek, Z. & Quirk, J. (1996). Botulinum toxin in the treatment of writer's cramp. Clin Neuropharmacol, 19, 314–20.
Wilson, F., Wagner, C. & Homberg, V. (1993). Biomechanical abnormalities in musicians with occupational cramp focal dystonia. J Hand Ther, 64, 234–44.
Wissel, J., Kabus, C., Wenzel, R., et al. (1996). Botulinum toxin in writer's cramp: objective response evaluation in 31 patients. J Neurol Neurosurg Psychiatry, 61, 172–5.
Zeuner, K. E. & Hallett, M. (2003). Sensory training as treatment for focal hand dystonia: a 1 year follow up. Mov Disord, 18, 1044–7.
Zeuner, K. E., Bara-Jimenez, W., Noguchi, P. S., et al. (2002). Sensory training for patients with focal hand dystonia. Ann Neurol, 51, 593–8.
Zeuner, K. E., Shill, H. A., Sohn, Y. H., et al. (2005). Motor training as a treatment in focal hand dystonia. Mov Disord, 20, 335–41.