Objective: Here we retrospectively analysed nineteen patients followed up in our centre, the Neurology Unit of the Penang General Hospital, for writer’s cramp from the year 1993 to 2019.

Background: Writer’s cramp is a fairly rare phenomenon that has been well described in literature since the nineteenth century.  There are many conflicting theories on the pathophysiology of this phenomenon, with psychological stressors being an important factor in many cases.

Method: All patients who visited our clinic and were diagnosed with writer’s cramp by a neurologist from the year 1993 to 2019 were included in this analysis. All nineteen patients’ data were categorized based on age of onset of symptoms, race, sex, occupation, pre-existing co-morbidities and physical examination findings. The treatment given and response to treatment were analyzed. As many of them were lost to follow up, they were contacted via telephone to enquire about the trigger of their symptoms and how they progressed over the years. The figures obtained were then summarized in a table (Table 1).

Results: Among the patients analyzed, seven (36.8%) were female while twelve (63.2%) were male. The age of onset ranged between 13 to 54 years, with the median age of onset being 36 years, and mean 33.3 years. In terms of occupation , six (31.6%)  of them were students, which encompass secondary school and university students,  while five were doing clerical jobs (26.3%).At the time of diagnosis, one patient had anxiety disorder and was already on medications while another had claustrophobia. Only four patients were known to have medical co-morbidites. When contacted, thirteen out of nineteen (68.4%) patients revealed that stressful situations in life had preceded the onset of symptoms. Only two patients (10.6%) did not feel that their symptoms were triggered or exacerbated by stress. Four were, unfortunately, not contactable (Table 3).

Conclusion: Writer’s cramp is a condition that is undoubtedly a physical entity with a significant psychological component. Therefore the combination of pharmacotherapy and stress management is equally important when treating writer’s cramp.

References: 1. Albanese A. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28:863–873. 2. Alastair Compston, From the Archives, Brain, Volume 136, Issue 7, July 2013, Pages 2011–2014.

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