Objective: To know the prevalence and clinical characteristics of tremor in writer’s cramp patients.

Background: Tremor is one of the important motor phenotypes of dystonia, however, there is a lacuna in the literature regarding the different factors associated with tremor in task-specific dystonia such as writer’s cramp (WC).^1,2

Method: A detailed chart review of 105 patients of WC, classified into 39 patients (37.1%) with WC with dystonic action tremor (WCT+) and 66 patients (53.9%) with WC with no tremor (WCT-).

Results: The mean age of patients was 41.10±14.02 years in the WCT+ group and 36.40±14.66 years in the WCT- group. Males were more commonly affected (94.9% in WCT+ and 84.8% in WCT-). The mean duration of disease was significantly higher in WCT+ as compared to WCT- (4.16±4.48 years vs 2.57±2.81 years, p = 0.024). The motor overflow was significantly associated with the presence of tremor (46.1% of WCT+ vs 15.2% of WCT- patients, p= 0.001). Mirror dystonia was present in 79.4% patients (n=31) in WCT+ and 68.2% patients (n=45) in WCT- group, however this difference was statistically not significant (p=0.211). No statistically significant differences were observed between WCT+ and WCT- regarding the presence of complex WC (p=0.976), generalized form of WC (p=0.060), flexion/extension abnormalities and dystonia in any other body part (p=0.186).

Conclusion: The presence of tremor in WC was associated with a longer duration of disease as well as the presence of motor overflow.

References: 1. Pandey S, Sarma N. Tremor in dystonia. Parkinsonism Relat Disord. 2016 Aug;29:3-9. 2. Goldman JG. Writer’s cramp. Toxicon. 2015 Dec 1; 107:98-104.

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