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Botulinum toxin for writer’s cramp: a randomised, placebo-controlled trial and 1-year follow-up
  1. J J M Kruisdijk1,
  2. J H T M Koelman1,
  3. B W Ongerboer de Visser1,
  4. R J de Haan2,
  5. J D Speelman1
  1. 1Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre
  1. Correspondence to:
 Dr J J M Kruisdijk
 Department of Neurology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;j.j.kruisdijk{at}


Background: Botulinum toxin type A (BoNT-A) has become the treatment of choice for most types of focal dystonia.

Objective: To investigate the efficacy of BoNT-A injections in patients with writer’s cramp in a double-blind, randomised, placebo-controlled trial and to evaluate the follow-up results.

Methods: Forty participants were randomised to treatment with either BoNT-A or placebo injections in two sessions. Trial duration was 12 weeks. The primary outcome measure was the patients’ choice to continue with the treatment, despite its possible disadvantages. Secondary outcome measures included several clinical rating scales on the levels of impairment and disability. Assessments were made at baseline and 2 months (secondary outcomes) and 3 months (primary outcome). Duration of follow-up was 1 year.

Results: 39 patients completed the trial. Fourteen of 20 patients (70%) receiving BoNT-A reported a beneficial effect and chose to continue treatment, versus 6 of 19 patients (31.6%) in the placebo group (p = 0.03). The changes on most of the clinical rating scales were significantly in favour of BoNT-A. Side effects reported were hand weakness, which was mostly mild and always transient, and pain at the injection site. After 1 year, 20 of 39 patients were still under treatment with a positive effect.

Conclusion: Treatment with BoNT-A injections led to a significantly greater improvement compared with placebo, according to patients’ opinion and clinical assessment scales. Weakness in the hand is an important side effect of BoNT-A injections, but despite this disadvantage, most patients preferred to continue treatment. About 50% of our patients were still under treatment after 1 year.

  • BoNT-A, botulinum toxin type A
  • FSS, functional status scale
  • SSS, symptom severity scale
  • VAS, visual analogue scale
  • WCRS, writer’s cramp rating scale

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  • Published Online First

  • Funding: Trial medication and an unrestricted research grant for the workgroup Movement Disorders at the Academic Medical Centre, University of Amsterdam was received from Ipsen Pharmaceutical. Ipsen Pharmaceutical had no role in study design, collection, analysis, interpretation of data, in the writing of the report and in the decision to submit the paper for publication. The study was funded by a grant from the Prinses Beatrix Fonds (MAR 00-0119). JHTMK received a travel grant from Allergan. JJMK received a travel grant from Ipsen.

  • Competing interests: None.