Writer's Cramp Medication

  • Author: Jonathan B Strober, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: May 10, 2012
 

Medication Summary

Several classes of drugs have been used in patients with writer's cramp. Anticholinergics have had conflicting results. Beta-blockers have helped the tremor in a few patients. Botulinum toxin injections seem to have the best results.

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Anticholinergic

Class Summary

Blocking cholinergic innervation of the basal ganglia is hypothesized to increase the dopaminergic effect, thereby reducing dystonia.

Trihexyphenidyl (Artane)

 

Substituted piperidine that inhibits parasympathetic system. Available as 2 mg tab or 2 mg/5 cc elixir.

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Beta-adrenergic blockers

Class Summary

These agents help reduce the tremor.

Propranolol (Inderal, Betachron E-R)

 

Class II antiarrhythmic, nonselective, beta-adrenergic, receptor blocker with membrane-stabilizing activity that decreases automaticity of contractions. Available as 10 mg, 20 mg, 40 mg, and 80 mg tablets and 60 mg, 80 mg, 120 mg, and 160 mg long-acting tablets (Inderal LA)

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Neurotoxins

Class Summary

Neurotoxin complex blocks neuromuscular conduction by binding to receptor sites on motor nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. When injected intramuscularly, it produces a localized chemical denervation muscle paralysis.

OnabotulinumtoxinA (BOTOX®)

 

Local intramuscular injections weaken overactive muscles, reducing dystonic symptoms.

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Contributor Information and Disclosures
Author

Jonathan B Strober, MD  Director, Pediatric Muscular Dystrophy Association Clinic; Associate Clinical Professor, Departments of Pediatrics and Neurology, Division of Child Neurology, University of California at San Francisco

Jonathan B Strober, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen T Gancher, MD  Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University

Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nestor Galvez-Jimenez, MD, MSc, MHA  Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

References
  1. Tinazzi M, Farina S, Bhatia K, Fiaschi A, Moretto G, Bertolasi L, et al. TENS for the treatment of writer's cramp dystonia: a randomized, placebo-controlled study. Neurology. Jun 14 2005;64(11):1946-8. [Medline].

  2. Goto S, Shimazu H, Matsuzaki K, Tamura T, Murase N, Nagahiro S, et al. Thalamic Vo-complex vs pallidal deep brain stimulation for focal hand dystonia. Neurology. Apr 15 2008;70(16 Pt 2):1500-1. [Medline].

  3. Baur B, Schenk T, Furholzer W, Scheuerecker J, Marquardt C, Kerkhoff G, et al. Modified pen grip in the treatment of Writer's Cramp. Hum Mov Sci. Oct 2006;25(4-5):464-73. [Medline].

  4. Chen R, Hallett M. Focal dystonia and repetitive motion disorders. Clin Orthop. Jun 1998;(351):102-6. [Medline].

  5. Chen RS, Tsai CH, Lu CS. Reciprocal inhibition in writer's cramp. Mov Disord. Sep 1995;10(5):556-61. [Medline].

  6. Cohen LG, Hallett M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. Jul 1988;38(7):1005-12. [Medline].

  7. Epidemiologic Study of Dystonia in Europe (ESDE) Collaborative Group. Sex-related influences on the frequency and age of onset of primary dystonia. Neurology. Nov 10 1999;53(8):1871-3. [Medline].

  8. [Best Evidence] Kruisdijk JJ, Koelman JH, Ongerboer de Visser BW, de Haan RJ, Speelman JD. Botulinum toxin for writer's cramp: a randomised, placebo-controlled trial and 1-year follow-up. J Neurol Neurosurg Psychiatry. Mar 2007;78(3):264-70. [Medline].

  9. Marsden CD, Sheehy MP. Writer's cramp. Trends Neurosci. Apr 1990;13(4):148-53. [Medline].

  10. Rhoad RC, Stern PJ. Writer's cramp--a focal dystonia: etiology, diagnosis, and treatment. J Hand Surg Am. May 1993;18(3):541-4. [Medline].

  11. Schmidt A, Jabusch HC, Altenmuller E, et al. Dominantly transmitted focal dystonia in families of patients with musician's cramp. Neurology. Aug 22 2006;67(4):691-3. [Medline].

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