Botulinum toxin and occupational therapy in the treatment of writer's cramp

Abstract

Objectives: To analyze the long term effect of botulinum toxin (BTX) injections and the efficacy of a structured occupational therapy program in patients with writer's cramp (WC).Study Design: We retrospectively investigated 28 patients with WC; 26 received BTX, 15 took part in a structured occupational training program, containing modification of the way of writing and employment of different writing devices. Two of these 15 patients had occupational therapy only, the others had the training program in addition to the BTX injections. The efficacy was evaluated using a self-assessment rating scale.Results: The mean follow-up was 20.2 months. Twentythree percent of BTX-treated patients reported a marked, 35% a moderate and 42% only minimal or no response after BTX at the best time. Patients with relatively localized forms of WC, i.e., involvement of finger or wrist muscles had a better response to BTX than patients with more complex forms of dystonia affecting various muscle groups. Thirty-three percent of the patients taking part in the occupational therapy training program reported a marked or moderate improvement after occupational therapy, whereas 47% reported only limited benefit but still an important additional effect to BTX. No benefit was reported by 20%. In patients with combined treatment, the reported improvement after occupational therapy was additive to BTX indicating that occupational therapy potentiates the effect of BTX.Conclusion: BTX is a very useful and effective therapy in a substantial proportion of patients with WC. A short structured occupational therapy program further improves the effect of BTX and may be the only form of treatment in single cases of WC patients.