Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-30T05:16:11.807Z Has data issue: false hasContentIssue false

Chapter 39 - Treatment of Focal Hand Dystonia

Published online by Cambridge University Press:  02 November 2023

By
Barbara Illowsky Karp ,
Chandi Prasad Das ,
Daniel Truong  and
Mark Hallett
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
Get access

Summary

Focal hand dystonia (FHD) is characterized by dystonic hand contractions that are often aggravated by purposeful actions and may be specific to a particular task. The term “occupational dystonia” is used when dystonia affecting performance of the job arises in individuals with a particular occupation, usually an occupation requiring repetitive and excessive fine motor activity.

One task-specific FHD, writer’s cramp, causes disabling spasms of the hands when attempting to write, and is particularly likely in people whose profession involves excessive writing. Musician’s dystonia (cramp) is applied to a focal dystonia localized to hand muscles controlling fine movements of the digits or the embouchure muscles involved in playing instruments.

Injection of botulinum neurotoxin (BoNT) is effective in writer’s cramp and other occupational dystonias. This chapter discusses the different common patterns of dystonic movement of the hand and arm, identifies the particular muscles active in each dystonia pattern to aid in target selectio, and illustrates the muscular anatomy and injection approach using anatomical diagrams. Guidance of injections with EMG is discussed. Dosing recommendations for three different BoNT formulations are tabulated.

Keywords

Focal hand dystoniaoccupational dystoiniamovement disorderwriter’s crampmusician’s dystoniayipsbotulinum neurotoxinabobotulinumtoxinABoNT
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 332 - 347
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, CH, Temkit, M, Crews, D et al. (2018). The yips: methods to identify golfers with a dystonic etiology/golfer’s cramp. Med Sci Sports Exerc, 50, 2226–30. http://doi.org/10.1249/MSS.0000000000001687CrossRefGoogle ScholarPubMed
Altenmuller, E, Jabusch, HC (2009). Focal hand dystonia in musicians: phenomenology, etiology, and psychological trigger factors. J Hand Ther, 22, 144–54; quiz 155. http://doi.org/10.1016/j.jht.2008.11.007CrossRefGoogle ScholarPubMed
Alter, KE, Karp, BI (2017). Ultrasound guidance for botulinum neurotoxin chemodenervation procedures. Toxins (Basel), 10. http://doi.org/10.3390/toxins10010018CrossRefGoogle ScholarPubMed
Bara-Jimenez, W, Catalan, MJ, Hallett, M, Gerloff, C, (1998). Abnormal somatosensory homunculus in dystonia of the hand. Neurology, 44, 828–31.Google ScholarPubMed
Berman, BD, Groth, CL, Sillau, SH et al. (2020). Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study. J Neurol Neurosurg Psychiatry, 91, 314–20. http://doi.org/10.1136/jnnp-2019-321794CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Chamagne, P (2003). Functional dystonia in musicians: rehabilitation. Hand Clin, 19, 309–16.CrossRefGoogle ScholarPubMed
Cho, CB, Park, HK, Lee, KJ, Rha, HK, (2009). Thalamic deep brain stimulation for writer’s cramp. J Korean Neurosurg Soc, 46, 52–5.CrossRefGoogle ScholarPubMed
Cole, RA, Cohen, LG, Hallett, M (1991). Treatment of musician’s cramp with botulinum toxin. Med Probl Perform Artists, 6, 137–43.Google Scholar
Conte, A, Defazio, G, Hallett, M et al. (2019). The role of sensory information in the pathophysiology of focal dystonias. Nat Rev Neurol, 15, 224–33. http://doi.org/10.1038/s41582-019-0137-9CrossRefGoogle ScholarPubMed
Das, SK, Banerjee, TK, Biswas, A et al. (2007). Community survey of primary dystonia in the city of Kolkata India. Mov Disord, 22, 2031–6.CrossRefGoogle ScholarPubMed
Djebbari, R, Dumontcel, ST, 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.CrossRefGoogle ScholarPubMed
Duffey, O, Butler, AG, Hawthorne, MR, Barnes, MP (1998). The epidemiology of the primary dystonias in the north of England. Adv Neurol, 78, 12–15.Google ScholarPubMed
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.Google Scholar
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.Google Scholar
Garraux, G, Bauer, A, Hanakawa, T et al. (2004). Changes in brain anatomy in focal hand dystonia. Ann Neurol, 55, 736–9.CrossRefGoogle ScholarPubMed
Granert, O, Peller, M, Jabusch, HC, Altenmuller, E, Siebner, HR, (2011). Sensorimotor skills and focal dystonia are linked to putaminal grey-matter volume in pianists. J Neurol Neurosurg Psychiatry, 82, 1225–31.Google Scholar
Hallett, M (1998). Physiology of dystonia. Adv Neurol, 78, 11–18.Google ScholarPubMed
Hallett, M (2000). Disorder of movement preparation in dystonia. Brain, 123, 1765–6.CrossRefGoogle ScholarPubMed
Hallett, M (2006a). Pathophysiology of dystonia. J Neural Transm Suppl, 70, 485–8.CrossRefGoogle Scholar
Hallett, M (2006b). Pathophysiology of writer’s cramp. Hum Mov Sci, 4–5, 454–63.Google Scholar
Hanekamp, S, Simonyan, K (2020). The large-scale structural connectome of task-specific focal dystonia. Hum Brain Mapp, 41, 3253–65. http://doi.org/10.1002/hbm.25012CrossRefGoogle ScholarPubMed
Hirt, L, Grassia, F, Feuerstein, J et al. (2021). Deep brain stimulation of the ventral intermediate nucleus of the thalamus in writer’s cramp: a case report. Tremor Other Hyperkinet Mov (N Y), 11, 46. http://doi.org/10.5334/tohm.645Google Scholar
Hsuing, GY, Das, SK, 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.Google Scholar
Jabusch, HC, Altenmuller, E (2006). Focal dystonia in musicians: from phenomenology to therapy. Adv Cogn Psychol, 2, 207–20.CrossRefGoogle Scholar
Jedynak, PC, Tranchant, C, Debeyl, DZ (2001). Prospective clinical study of writer’s cramp. Mov Disord, 16, 494–9.CrossRefGoogle ScholarPubMed
Karp, BI (2004). Botulinum toxin treatment of occupational and focal hand dystonia. Mov Disord, 19(Suppl 8), S116–19.CrossRefGoogle ScholarPubMed
Karp, BI, Cole, RA, Cohen, LG et al. (1994). Long term botulinum toxin treatment of focal hand dystonia. Neurology, 44, 70–6.CrossRefGoogle ScholarPubMed
Lee, H, Delisa, J (2000). Surface Anatomy for Clinical Needle Electromyography. New York: Demos Medical Publishing.Google Scholar
Lungu, C, Karp, BI, Alter, K et al. (2011). Long-term follow-up of botulinum toxin therapy for focal hand dystonia: outcome at 10 years or more. Mov Disord, 26, 750–3.Google Scholar
McDaniel, KD, Cummings, JL, Shain, H (1989). The “yips”: a focal dystonia of golfers. Neurology, 39, 192–5.CrossRefGoogle ScholarPubMed
Molloy, FM, Shill, HA, Kaelin-Lang, A, Karp, BI (2002). Accuracy of muscle localization without EMG: implications for treatment of limb dystonia. Neurology, 58, 805–7.Google Scholar
Newmark, J, Hochberg, FH (1987). Isolated painless manual incoordination in 57 musicians. J Neurol Neurosurg Psychiatry, 50, 291–5.CrossRefGoogle ScholarPubMed
Nutt, JG, Muenter, MD, Aronson, A et al. (1988). Epidemiology of focal and generalised dystonia in Rochester Minnesota. Mov Disord, 50, 361–5.Google Scholar
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.CrossRefGoogle Scholar
Ramazzini, B (1713). Diseases of scribes and notaries. In Diseases of Workers. New York: Hafner, pp. 421–5.Google Scholar
Rosenbaum, F, Jankovic, J (1988). Focal task-specific tremor and dystonia: categorization of occupational movement disorders. Neurology, 38, 522–7.CrossRefGoogle ScholarPubMed
Sanger, TD, Tarsy, D, Pascual-Leone, A (2001). Abnormalities of spatial and temporal sensory discrimination in writer’s cramp. Mov Disord, 16, 94–9.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Schill, J, Zeuner, KE, Knutzen, A et al. (2021). Functional neural networks in writer’s cramp as determined by graph-theoretical analysis. Front Neurol, 12, 744503. http://doi.org/10.3389/fneur.2021.744503CrossRefGoogle ScholarPubMed
Simonyan, K, Cho, H, Hamzehei Sichani, A, Rubien-Thomas, E, Hallett, M (2017). The direct basal ganglia pathway is hyperfunctional in focal dystonia. Brain, 140(12), 3179–90. http://doi.org/10.1093/brain/awx263CrossRefGoogle ScholarPubMed
Simpson, DM, Blitzer, A, Brashear, A et al. (2008). Assessment: botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70, 1699–706.Google Scholar
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.CrossRefGoogle ScholarPubMed
Soland, VL, Bhatis, KP, Marsden, CD (1996). Sex prevalence of focal dystonias. J Neurol Neurosurg Psychiatry, 60, 204–5.CrossRefGoogle ScholarPubMed
Solly, S (1864). Clinical lectures on scriveners’ palsy, or the paralysis of writers. Lancet, 84, 709–11.Google Scholar
Stahl, CM, Frucht, SJ (2017). Focal task specific dystonia: a review and update. J Neurol, 264, 1536–41. http://doi.org/10.1007/s00415-016-8373-zCrossRefGoogle ScholarPubMed
Taira, T, Harashima, S, Hori, T (2003). Neurosurgical treatment for writer’s cramp. Acta Neurochir, 87(Suppl), 129–31.Google Scholar
Tsui, JKC, Bhatt, M, Calne, S, Calne, DB (1993). Botulinum toxin in the treatment of writer’s cramp. A double blind study. Neurology, 43, 183–5.CrossRefGoogle ScholarPubMed
Tubiana, R (2003). Musician’s focal dystonia. Hand Clin, 19, 303–8.CrossRefGoogle ScholarPubMed
Turjanski, N, Pirtosek, Z, Quirk, J et al. (1996). Botulinum toxin in the treatment of writer’s cramp. Clin Neuropharmacol, 19, 314–20.CrossRefGoogle ScholarPubMed
Wilson, F, Wagner, C, Homberg, V (1993). Biomechanical abnormalities in musicians with occupational cramp focal dystonia. J Hand Ther, 64, 234–44.Google Scholar
Wissell, 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.Google Scholar
Zakin, E, Simpson, DM (2021). Botulinum toxin therapy in writer’s cramp and musician’s dystonia. Toxins (Basel), 13, 899. http://doi.org/10.3390/toxins13120899CrossRefGoogle ScholarPubMed
Zeuner, KE, Bara-Jimenez, W, Noguchi, PS et al. (2002). Sensory training for patients with focal hand dystonia. Ann Neurol, 51, 593–8.CrossRefGoogle ScholarPubMed
Zeuner, KE, Hallett, M (2003). Sensory training as treatment for focal hand dystonia: a 1 year follow up. Mov Disord, 18, 1044–7.Google Scholar
Zeuner, KE, Shill, HA, Sohn, YH et al. (2005). Motor training as a treatment in focal hand dystonia. Mov Disord, 20, 335–41.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×