Two cases of refractory writer's cramp in pain clinic: Is botulinum the answer?

Abstract

Introduction: Writer's cramp is a refractory painful disorder, often presenting as a disabling disease while writing for a short duration. The conventional therapy in the form of neurogenic agents such as carbamazepine often fails to benefit these patients. Modern literature has highlighted the used of botulinum toxin in focal dystonisas and hence its use can also be extrapolated in patients of writer's cramps.

Aim: Evaluating the efficacy and safety of botulinum toxin in refractory writer's cramps.

Methodology: We present 2 cases of diagnosed refractory writer's cramp. These patients were evaluated for group of hand muscles involved. Once the muscles were identified, botulinum toxin was injected into these muscles and clinical response was used to iterate the total dose of botulinum needed. These patients were followed up for degree of relief and any associated adverse effects.

Results: Both patients showed significant clinical relief after the use of botulinum toxin. Their writing time improved and both patients reported a significant pain relief. The patients required repeat injection after 3-6 months, however with each reoccurrence their ailment decreased and they could be taken off oral medication. Minor clinically insignificant reversible weakness was seen in one patient, which reverted to normal in 2-3 weeks time which did not affect patients' satisfaction to treatment, as the primary disease was disabling for daily professional work.

Conclusion: Botulinum toxin is a safe and effective therapeutic option for treating patients of refractory writer's cramp presenting in the pain clinic.