Botulinum toxin treatment with EMG and ultrasound guidance for focal and segmental dystonia. Writer's cramp can be an initial part of segmental dystonia as well.
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Botulinum toxin treatment of focal dystonia: writer’s cramp. Case report.
1. Botulinum toxin kezelés fokális
dystoniában: írásgörcs. Esetbemutatás.
Dr. Szirtesiné Dr. Varga Edina Tímea
8th June 2018.
Botulinum toxin treatment of focal dystonia:
writer’s cramp. Case report.
2. Botulinum toxin kezelés fokális
dystoniában: írásgörcs. Esetbemutatás.
Dr. Szirtesiné Dr. Varga Edina Tímea
8th June 2018.
Botulinum toxin treatment of focal dystonia:
writer’s cramp. Case report.
Sandoz
3. Writer’s cramp: task-specific focal hand dystonia initiated
or worthened by voluntary muscle contraction
http://pn.bmj.com/content/early/2017/08/26/practneurol-2017-001719
5. Focal limb dystonia
• adult onset: IV-V. decade
• limited to one limb or a part of a limb
• (but can be a part of hemisegmental,
multifocal or generalized dystonia)
• spreads towards proximal mucles, affects
both hands
• develop during weeks/months
• can later progress, though rather a static
condition
• 25% + family history (DYT6, arylsulfatase G
gene variants: musician’s cramp and writer’s
cramp)
Toxins 2018:10,20
„mirror dystonia”
6. Case report
• 49 y old male, teacher
• symptom onset: Sep 2017, progression
• presented at clinic: May 2018
• dominant right hand involvement
• progression during task (writing), but can
shave, brush tooth
• muscle cramp, pain in upper
arm, shoulder
• cramp is reduced by
extended elbow
7.
8. Case report
• 49 y old male, teacher
• symptom onset: Sep 2017, progression
• presented at clinic: May 2018
• dominant right hand involvement
• progression during task (writing), but can
shave, brush tooth
• muscle cramp, pain in upper
arm, shoulder
• cramp is reduced by
extended elbow
16. Conclusion, plan
Partial, initial effect on writing after 21 days
Pain reduction!
Plan:
↑ the dose injected into m. pronator teres
select other muscles:
palmar interossei
17. Conclusion, plan
Partial, initial effect on writing after 21 days
Pain reduction!
Plan:
↑ the dose injected into m. pronator teres
select other muscles:
palmar interossei
lumbricals manus
18. Conclusion, plan
Partial, initial effect on writing after 21 days
Pain reduction!
Plan:
↑ the dose injected into m. pronator teres
select other muscles:
palmar interossei
lumbricals manus
flex.dig.prof.
19. Conclusion, plan
Partial, initial effect on writing after 21 days
Pain reduction!
Plan:
↑ the dose injected into m. pronator teres
select other muscles:
palmar interossei
lumbricals manus
flex.dig.prof.
combine US+EMG
(myojet/boject needles)
20. How to improve botulinum toxin treatment?
https://www.poole.nhs.uk/
Dystoni:Enbevᴂgelsesforstyrrelse2008.