Writer's cramp

• Writer's cramp is the most common form of focal, task-specific dystonia.
• Treatments include both pharmacologic and non-pharmacologic approaches.
• There have been several randomized trials of chemodenervation for writer's cramp.
• Botulinum toxin injection is currently the treatment of choice for writer's cramp.
• Neurosurgery, neuromodulation, and rehabilitation therapies have also been studied.

Writer's cramp is the most common form of focal, task-specific dystonia. Symptoms frequently evolve in the setting of repetitive hand movements and increased writing demands, and clinical presentations demonstrate a variety of different dystonic patterns of the upper extremity such as while writing or holding a writing utensil. However, why writer's cramp develops still remains much of a mystery. Clinical evaluation of patients with writer's cramp and various theories regarding its pathophysiology are reviewed. Treatment can be challenging and often involves a combination of pharmacologic (e.g., oral medications, botulinum toxin injections) and non-pharmacologic approaches (e.g., neurosurgical or neurostimulatory interventions, rehabilitation therapies, adaptive devices). Management strategies for writer's cramp using both of these approaches will be discussed.