Writer's cramp

　　1. Etiology

　　This disease mostly belongs to a neurological functional disease. Some scholars believe that the disease belongs to extrapyramidal system disorders or consider it a reflexive disorder of the sympathetic nervous system.

　　2. Pathogenesis

　　Hyper-tonic muscle tension is the most common, causing hand muscle and wrist muscle spasms during writing; or due to weak muscle strength, the pen cannot be used freely, resembling a paralytic state; there is also an overactive type, where hand muscle and wrist muscle tremors occur during writing, gradually intensifying, and are more pronounced during periods of mental tension. This is the result of a disorder between the agonist and antagonist muscles.

　　No special records, or there may be idiopathic tremor or neurological sign manifestation.

　　Idiopathic Tremor:Also known as familial or benign idiopathic tremor, it is a common movement disorder disease, showing autosomal dominant inheritance. Postural or action tremor is the only manifestation, with a slow progression or no progression over a long period. Currently, age is considered an important risk factor for ET, and the prevalence increases with age. The onset is slow, and it can occur at any age, but it often starts in adulthood. Some literature reports that males are slightly more than females.

　　This disease mainly occurs in people aged 20 to 50 who have been engaged in writing for a long time, especially those who work with words. Some patients have a positive family history. Most cases start slowly and progressively, first feeling fatigue in the fingers or pain in the wrist, followed by the characteristic writer's cramp. It is difficult for patients to hold a pen or start writing, and this spastic phenomenon mainly occurs in the fingers, wrist, or even the entire upper limb. The most important feature of this disease is that spasms occur during writing, while symptoms disappear when not writing, and muscle strength is completely normal. Sometimes, it is only difficult to use a small pen, but completely normal when using a pencil or a large pen. Patients can work normally without any disability. This disease mostly belongs to a neurological functional disease, but some cases show higher muscle tension in the interphalangeal or wrist joints during examination, with a gear-like resistance when the wrist joint is passively rotated. Therefore, some people believe that this disease belongs to extrapyramidal system disorders, while others consider it a reflexive disorder of the sympathetic nervous system.

　　In clinical practice, writer's cramp can be divided into three types:

　　1. Spastic Type (Hyper-tonic Muscle Tension Type):This is the most common type, causing hand muscle and wrist muscle spasms or alternating contraction states quickly during writing.

　　2. Paralytic Type (Weakness Type):The patient feels fatigue and weakness when writing, due to weak muscle strength, which cannot be freely controlled, resembling a paralytic state and making it impossible to use a pen. Sometimes, pain occurs along the nerve pathways.

　　3. Tremor type (hyperkinetic type):Hand tremors can be seen when writing, and the tremors gradually increase with writing, especially under the influence of mental stress, which is more significant. This kind of performance is the result of disorganization between the active muscles and the antagonistic muscles.

　　For those with a genetic background, it is recommended to carry out genetic counseling, carrier gene detection, prenatal diagnosis, and selective artificial abortion to prevent the birth of children. Preventing and treating书写痉挛 syndrome is a measure to care for the health of intellectuals.

　　Playing iron balls (i.e., fitness balls) is an effective method to prevent the disease. Massage also has certain preventive and therapeutic effects. It can be massaged by doctors or self-massage. When massaging, the main massaging areas are those prone to spasm, and also can massage the acupoints such as pain points, Zusanli, Yangxi, and Jiaji.

　　1. Laboratory tests

　　Blood electrolytes, drugs, trace elements and biochemical tests are helpful for the differential diagnosis of the disease.

　　2. Other auxiliary examinations

　　CT and MRI examinations are meaningful for the differential diagnosis of intracranial diseases and are relatively easy to find. Electromyography is meaningful for differential diagnosis. Genetic analysis is of great significance for the differential diagnosis of certain hereditary dystonia diseases.

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　　1. Treatment

　　The symptoms of some书写痉挛 patients may improve after drinking. About half of the patients can alleviate symptoms by taking propranolol and clonazepam, and a small dose of phenobarbital (62.5mg/d) is also effective for tremors. Local injection of botulinum toxin type A is also effective. At the same time, it is recommended that patients change to another handwriting method or use tools.

　　2. Prognosis

　　Because the primary symptoms of primary书写痉挛 are relatively stable, there is rarely a tendency for spread and aggravation.