Objective: To describe a case of task-specific tremor and dystonia.

Background: Task-specific tremor is a type of action tremor that occurs during specific tasks such as writing or speaking. Task-specific dystonia is a focal dystonia involving muscle contractions with abnormal posturing during specific motor activities. Task-specific tremor and dystonia can be concurrently present in the same limb, but rarely has been reported spreading to the other side [1,2].

Method: Case report.

Results: A 66-year-old architect developed right hand tremulousness 40 years ago while writing and drawing sketches. Subsequently, his hand would adopt a dystonic posture while writing associated with a large amplitude tremulous movement. He began to use his left side, however over time the left hand also started assuming an abnormal posture only associated with writing [Figure 1]. He had no tremor with other activities.There was no benefit with propranolol up to a dose of 120 mg. MRI of the brain was normal. A surface electromyography study demonstrated a position and task dependent tremor along with phasic agonist and antagonist muscle co-contraction suggestive of dystonic tremor without evidence of an essential tremor. He deferred other therapeutic options such as botulinum toxin or deep brain stimulation since the tremor was only associated with writing and he was able to cope by typing or dictating instead.

Conclusion: We present a rare case of task-specific tremor and dystonia with contralateral spread. The evolution of dystonia spreading to the contralateral limb is rare but should be monitored for in individuals prone to developing task specific movement disorders.

References: [1] Rosenbaum F, Jankovic J. Focal task-specific tremor and dystonia categorization of occupational movement disorders. Neurology 1988; 38(4). [2] Torres-Russotto D, Perlmutter JS. Task-specific dystonias: a review. Ann N Y Acad Sci 2008;1142:179–99.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/case-of-task-specific-tremor-and-task-specific-dystonia-with-contralateral-spread/