|Most of the treatment options available for writer's cramp are directed towards treating the symptoms of the disease, rather than the underlying causes. Since the CNS areas affected by writer's cramp are so broad and the exact abnormalities are unclear, symptomatic treatment is a much more reasonable approach. Treatment options include:|
As a first approach, many patients try altering their grip of the writing utensil. Although spasms usually return to affect the new grip, this method provides some temporary relief. Special writing utensils may also be used, including pens with larger grips and pens mounted on rolling devices to glide across the paper. However, some patients may feel uncomfortable or embarrassed about such devices. Some patients switch to writing with their unaffected hand; however, due to the bilateral nature of the dysfunction (see Pathophysiology), approximately 25% of patients experience symptoms in this hand as well.
Many methods of alternative medicines have been tried for treatment of writer's cramp, including acupuncture, chiropractic techniques, osteopathy, physiotherapy, homeopathy, hypnotherapy, dietary modifications, relaxation techniques, habit reversal, biofeedback, and aversion training with an electrified pen. While some patients find relief with these treatments, they have not been investigated in enough detail to reach any conclusions.
Almost every different type of psychotherapeutic drug has been tried as a treatment for writer's cramp. These drugs include levodopa/carbidopa, baclofen, benzodiapines, and dopamine depletors. The most commonly used drugs are anticholinergic medications, but unwanted side effects are usually unacceptable to patients. Drug therapy means a lifetime treatment course, which is also undesirable and reduces compliance.
Botulinum toxin injections have been used to treat other forms of dystonia and are now gaining popularity as a treatment for writer's cramp. The toxin is injected into overactive muscles to weaken them, theoretically improving control over the fingers. This treatment has shown promising results in clinical tests for all subgroups of writer's cramp (simple, progressive, and dystonic). Treated patients report improvements in dystonic posture, writing tremor, and writing speed. rCBF scans reveal that the primary motor cortex activation does not change in response to botulinum toxin treatments, while the caudal SMA shows an increase in activity. These changes could be due to a change in movement strategies enacted when muscles are weakened by botulinum toxin injections, or by cortical reorganization occurring because of the effective deafferentation of the cortex from the motor neurons. Although this treatment shows a great deal of promise, there are still drawbacks. Botulinum toxin injections do not work for everyone (see My Story). Also, overactive muscles may have be identified using a painful EMG procedure. Fortunately, more treatment centers are now relying on visual inspection to identify the target muscles. Too high a dosage of botulinum toxin may cause unintended weakness of neighboring muscles, interfering with other activities. Finally, repeated dosages of botulinum toxin may cause the formation of antibodies in a patient, rendering the treatment ineffective. Despite these drawbacks, botulinum toxin injections remain the treatment of choice for writer's cramp.