Article

Writer's cramp is a focal dystonia; treatment remains
disappointing. We report our 14-year experience with a population of 119 patients
aged between 18 and 85 years (average age 43 years).
METHODS: Treatment was based
on botulinum toxin injections (Dysport) and physiotherapy. Patients were reviewed
every four to six months with clinical and video evaluation by three different
observers and subjective analysis of the treatment efficiency by the patient
(score of 1 to 3). The post-injection deficit, if present, was also quantified.
RESULTS: In the group treated with toxin and physiotherapy, cramps improved
(score 2 and 3) in 61.6% of patients; a majority of patients (n=14) reported they
were moderately satisfied (score 2). In the group treated with toxin alone, 37.9%
of patients were improved (score 2 and 3) with a majority (n=18) very satisfied
reporting normal writing (score 3). Age was not a predictor of therapeutic
response. Good results were obtained with injections of the flexor carpi radialis
followed by flexor digitorum profundus II and III and the flexor pollicis longus.
Seventy-one per cent of injections caused moderate muscle weakness, minimally
disabling compared to the benefit of injections. Twenty-seven patients were
followed for more than two years and three patients, who had achieved score 3
with excellent response, were followed for 14 years with very efficient repeated
injections. If the injections were not effective the first time, we re-assessed
the situation and adjusted the injections; we considered that toxin treatment was
unsuccessful after three injections without benefit. CONCLUSION: The choice
treatment for writer's cramp remains well-targeted injections of botulinum toxin.
Physiotherapy is useful when the toxin injections are ineffective in completely
improving writing. This requires close cooperation between the injector, the
physiotherapist and the patient.

Langue : FRANCAIS