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Factors predicting improvement in motor disability in writer’s cramp treated with botulinum toxin
  1. R Djebbari4,
  2. S T du Montcel3,
  3. S Sangla1,
  4. J S Vidal1,
  5. G Gallouedec1,
  6. M Vidailhet2
  1. 1Department of Neurology, Hôpital Saint-Antoine, Paris, France
  2. 2INSERM U289, Pitié-Salpêtrière Hospital, Paris
  3. 3Biostatistics Department, Pitié-Salpêtrière Hospital, Paris
  4. 4Department of Neurosurgery, Beaujon Hospital, Paris
  1. Correspondence to:
 Dr M Vidailhet
 Service de Neurologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France;


Objective: To identify factors predicting improvement in motor disability in writer’s cramp treated with botulinum toxin (BTX).

Methods: 47 patients with writer’s cramp were treated with BTX and were evaluated by the same neurologists at initial referral, after each BTX injection, and when the effect of BTX was maximal at the time of the study. Patients and examiners simultaneously and independently rated the efficacy of BTX injections. Self assessment was a global clinical impression of the impact of treatment on writing quality, writing speed, writing errors, and legibility of handwriting; for objective assessment, the examiners used the Burke-Fahn-Marsden (BFM) scale.

Results: On the BFM scale, there was a significant improvement (p<0.0001) in both severity and disability scores. Patients with a pronation/flexion pattern of dystonia showed the best and the most sustained improvement. Primary writing tremor was little improved. There was a correlation between the self assessment score and the Burke-Fahn-Marsden score. Benefit was maintained over time

Conclusions: These results have implications for the identification of patients most likely to benefit from BTX injections.

  • BFM, Burke-Fahn-Marsden scale
  • BTX, botulinum toxin
  • writer’s cramp
  • botulinum toxin

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  • Competing interests: none declared