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Writing tremor myoclonus
1Department of Medicine, Palmetto General Hospital, Hialeah, Fla.
European Neurology
|January 1, 1988
Summary
This case study details a patient with primary writing tremor, noting unusual symptoms like finger abduction and limb myoclonus. The findings highlight a rare presentation of writing tremor without dystonia, challenging typical classifications.
Area of Science:
- Neurology
- Movement Disorders
Background:
- Primary writing tremor is a focal dystonia characterized by involuntary muscle contractions during writing.
- Dystonia, often associated with writer's cramp, is typically present in primary writing tremor cases.
- Understanding atypical presentations is crucial for accurate diagnosis and management.
Observation:
- A patient presented with a 9-year history of primary writing tremor.
- The patient exhibited atypical features including spontaneous postural tonic abduction and tremor of the right index finger.
- Additional unusual symptoms included unidirectionality of tremor, writing-associated and independent bilateral proximal upper limb myoclonus.
- No improvement was observed with intravenous benztropine or lidocaine infiltration.
- Crucially, no dystonia was clinically evident.
Findings:
- The case demonstrates a rare instance of primary writing tremor occurring without the typical presence of dystonia.
- The observed symptoms, including finger abduction and myoclonus, deviate from classic descriptions of writer's cramp.
- Treatment with benztropine and local anesthetic infiltration proved ineffective.
Implications:
- This case expands the known spectrum of primary writing tremor, suggesting sporadic occurrences without dystonia are possible.
- It underscores the importance of considering atypical presentations in movement disorder diagnosis.
- Further research may be needed to classify and treat such unique tremor variants.