Writer’s cramp or graphospasm
by Kalyan B Bhattacharyya, Kalyan Satish V

Atlas of Neurology—A Case-based Approach

by Satish V Khadilkar, Kalyan B Bhattacharyya
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This is a variety of focal dystonia which is caused by motor overflow from the active muscles while writing and it suggests the presence of widespread abnormalities in motor control. This is most probably due to lack of motor inhibitory process and may be due to overwork as is shown electrophysiologically by enlargement of the motor homunculus controlling the long flexors and extensors of the forearm and the small muscles of the hand, and it is seen that this disease afflicts those who overuse these muscles like, typists and clerks in big office for many years. In order to recognize which muscles are affected, electromyographic studies are undertaken or the patient is asked to write with the unaffected hand and the neurologist observes the posture of the affected hand, and thus recognizes the overacting muscles. This is known as ‘mirror writing.’

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