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Mon 1 Jan 2007 01:50 PM

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Botox ‘effective’ for writer’s cramp

Botulinum toxin is an effective treatment for writer's cramp, suggests a small study published ahead of print in the Journal of Neurology Neurosurgery and Psychiatry.

Botulinum toxin is an effective treatment for writer's cramp, suggests a small study published ahead of print in the Journal of Neurology Neurosurgery and Psychiatry.

In a 12-week study of 40 participants with writer's cramp, those receiving one or two injections of the toxin significantly improved on several clinical rating scales compared with placebo, report Dr José J.M. Kruisdijk, of the University of Amsterdam, and colleagues.

In addition, more than twice as many participants in the treatment group versus placebo group chose to continue with the treatment after the 12 weeks, say the team.

Writer's cramp is a focal hand dystonia brought on by writing with a pen or pencil or other manual tasks. Therapies include physical treatment, postural exercises, relaxation techniques, and special writing devices, "but most of the patients do not obtain satisfactory and sustained benefit," they added.

The 40 study participants were randomized to a placebo injection or an injection of BoNT-A (botulinum toxin type A). Participants were assessed after one month and given a second injection if there was no response to the first.

Fourteen of 20 patients in the treatment group (70%) reported a beneficial effect and chose to continue treatment after three months, compared with six of 19 patients (31.6%) in the placebo group. Patients in the treatment group showed more improvement on several clinical assessments including a visual analogue handwriting scale, a writer's cramp rating scale, a writing speed assessment, and an overall symptom severity scale, the study found.

The treatment group did not do significantly better on a functional status scale. "This can be explained by a deterioration of several item scores owing to BoNT-A-induced weakness, although scores for the writing items improved," the team said.

Weakness in the hand was the chief adverse event of treatment, affecting 18 of the 20 patients in the treatment group. Pain at the injection site was the second most common adverse event. Both weakness and pain were always temporary and patients recovered completely.

All patients were offered treatment at the conclusion of the trial. At one year of follow-up, 20 of the 39 remaining patients were still under treatment "with positive effect," the authors said.

The study demonstrated that botulinum toxin injections were safe and effective compared with placebo for this difficult-to-treat condition, the team concluded.

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