Objective: To examine and characterize an observed movement disorder in our clinic and consider it in the context of the currently-established types of Task Specific Focal Dystonias (TSFD) with the hope of providing some improvement for this patient and others that might present with similar findings.

Background: Ever since the early part of the 19th century when ‘scrivener’s palsy’ was identified in office workers who had to copy documents by hand, dystonias have been identified in the setting of various occupations. Tradesmen as well as musicians and sportsmen have also accumulated a list of action-related dystonias. We identified a task-specific focal dystonia (TSFD) in a patient who noted the distal dominant limb spasms during her spiritual congregations when it was common practice to dance in prayer.

Methods: A review of the patient’s signs and symptoms was done to understand this condition further, especially to differentiate the condition from frontal tonic seizure as it was initially diagnosed.

Results: A middle-aged woman in the armed forces presented with prior history of carpal tunnel syndrome, carpal tunnel release, tendinopathy in the R>L upper extremities with trigger finger release procedures of the D2 and D4 of the dominant hand. These procedures yielded significant improvement of these common disorders. Several years after those complaints, the patient noted an intermittent involuntary flexion contraction of the right wrist that occurred while she was waving her arms overhead, singing, dancing during prayer services. The spasms lasted several minutes and there was no abnormal activity between the tonic episodes. She also noted this occurred while cheering at her son’s football games but not at work or on other occasions. Initial neurological evaluation led to a diagnosis of tonic seizures and the patient was recommended to take anticonvulsant medication but she declined, noting that the spasms occurred too infrequently for her to believe it was warranted as well as an aversion to medication in general. Our evaluation identified the abnormal movement as dystonia rather than tonic seizure. Indeed, epilepsy work-up was negative.

Conclusions: TSFD is not uncommon for neurologists to see but without an association to a previously-described task such as an occupation, musical or sporting activity, the diagnosis does not readily come to mind and can be difficult to make. Reports of unique types of TSFD can help us as neurologists in evaluating and treating these disorders.

References: 1. Liuzzi, D, Gigante AF, Leo, A, DeFazio G. Neurol Sci. 2016 Sep;37(9):1393-8. The Anatomical Basis of Upper Limb dystonia: lessons from secondary cases. 2. Charness, Micheal E. Office Practice of Neurology (Second Edition), 2003, 827-830. Chapter 130 – Task-Specific Focal Dystonia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prayer-dancing-dystonia-a-novel-form-of-non-occupational-task-specific-focal-dystonia/