Association of Lluita ALDEC against Dystonia in Catalonia

August 29, 2013 – 01:54
Hamilton | Dystonia Medical Research Foundation Canada

Writer's cramp: A FORM OF Dystonia It is a neurological disorder that causes contractions movement and involuntary muscle spasms. Its many variants affect different body parts including neck and shoulders, vocal cords, eyelids and limbs. Sometimes the spasms are painful. Dystonia is the third most common movement problem after Parkinson's and essential tremor, and is thought to affect about 300, 000 people in the United States. Because of its complexity, dystonia is poorly understood by the public and often misdiagnosed by doctors. What is the writer's cramp? Specific activities may induce the appearance of dystonia in specific areas. Being closely related to specialized activities, these dystonias linked to actions or tasks are called occupational dystonia. The writer's cramp is the best known of occupational dystonia, and appears only when the patient attempts to write or perform other actions precision by hand, such as playing a musical instrument. The muscles of the mana and fingers shrink or stretch, stopping the action or causing an exaggerated position. Some patients perceive as if the hand was blocked during attempted removal on paper and depicting him as it seems that "the hand thinks for itself." As soon as the writing instrument leaves the hand, it relaxes. The writer's cramp has been recognized as a medical problem since the nineteenth century when it was first reported, specifically the 1830s. Its cause is unknown and suspect that very often not diagnosed as such errors are the most common diagnosis of carpal tunnel syndrome, tennis elbow, tension, stress or psychogenic problems. Diagnosis and Symptoms The diagnosis of writer's cramp is based solely on clinical observation. In some cases an electromyogram can show that muscles are hyperactivated and what grade they are. The first symptoms may appear as soon as you pick up the pen, or after typing a few words. Usually the disease manifests between 30 and 50 years of age, and affects both men and women. Described two types of cramp: the simple, and dystonic. Patients with the present simple type only at the time of writing, as soon as you pick up the pen (or typing the first few letters) dystonic postures of the hand begin to interfere with the speed and accuracy of writing. The most common manifestations of this type are gripping the pen too tightly, often bending and deviation of the wrist, elbow and even elevation occasional stretch of one or more fingers, resulting in this case the fall of the writing instrument. In some cases, the disorder progresses to the point of elevation also cause shoulder and arm retraction while to write. In rare cases tremor is seen instead of dystonic postures maintained. In those affected by dystonic type cramp symptoms also appear when using other tools and activities, such as handling forks, when applying makeup, shaving, and in the use of scissors, screwdrivers and other tools diferentas of those are common escritura.No hand paralysis or pain, although there may be slight discomfort in the fingers, wrist or forearm. A cramp like musicians can affect the type the violin, some practitioners athletes like golf, or typists. Prognosis The course of dystonia is variable, so it is difficult to predict the evolution of the disease. Sometimes's cramp can progress in severity and affected areas after years of stability, but in most cases the intensity remains relatively stable. Although in some cases have been described but rarely, patients with spontaneous improvement writer's cramp. Current therapies Unfortunately no cure yet for dystonia, although treatments are available that claim to alleviate both painful symptoms such as spasm and the effects caused by the alteration of positions and functions. The goal of any treatment, including this one, is to get the greatest benefits incurring minimal risk. This requires balancing the risks and benefits and start with the less risky. Establish what the successful treatment may be something that requires patience on the part of the patient and the physician. Conservative therapies The conservative approach to minimize writing sewed with the affected hand, instead using other methods of communication as typing, dictation or using a writing device. The recorders can be useful in class, or in other situations where it is necessary to take notes. These recordings can then be transcribed in less stress situations. Some patients have found that strengthen and expand the circumference of their pens with foam or thick plastic, they find beneficial. Many affected develop specific methods to keep writing. You can help him do it with a different hand position, some endure the pen vertically empuñándolo between index and middle fingers that are excessively bent. Others grab him with a closed fist, or transfer the pen between the thumb and first finger, the space between the first and second toe, in other cases, the patient stabilizes the affected arm using the opposite hand. It is important in any case remember to avoid holding the pen in a static position and prolonged, writing in short periods, and rest often. Interestingly, the cramp does not appear when you type in wall boards. If these strategies do not work, you may want to learn to write with the other hand. However, some patients show dystonic postures primary mirror in hand, and it can happen that symptoms develop also in the opposite hand. This confirms that it is a problem caused in the brain, and not a local condition limb. Medication Drug treatment has been disappointing. Some substances anticholinergic effect may help some patients, but often are of limited use because of their side effects. Botulinum toxin injections Botulinum toxin injections into selected muscles are useful in the treatment of various local dystonias, including writer's cramp, especially when there is a significant deviation of the wrist or fingers. Botulinum toxin is a complex protein produced by a bacterium, Clostridium botulinum, which can weaken muscles enough to reduce the spasm but not enough to cause paralysis. It is a nerve block, which binds to the nerve endings in the muscles and prevents the release of chemicals that trigger. These substances are those that carry the "message" that comes from the brain that tells the muscle to contract. If the message is intercepted, then the spasm does not occur. The toxin is injected with tiny needles and usually occurs only some transient discomfort treaty. No beneficial effects usually begin to produce up to 5 or 10 days later, and may persist for three to four months with few side effects mínimos.Aunque this treatment is not effective for all concerned, it has been shown to improve writing and pain reduction of at least two-thirds of those treated. Some patients benefit from a sustained functional improvement after injections of botulinum toxin. Surgical Treatment Since very locally cramp affects muscles of the hand and arm, and only during specific activities such as writing, is not considered in this case the possibility of surgery. Occupational Therapy Physical therapy can help improve the local flexibility of the arm, which will be reduced by dystonic spasms and strengthening muscles unaffected. Occupational therapy can be used to practice writing techniques assisted or different, as well as other methods of communication. You can also improve hand coordination for common activities such as cooking, eating and dressing. Although it is true that stress does not cause writer's cramp, many affected people have noted that under stress your symptoms worsen. Unfortunately it is impossible to eliminate all sources of stress, but a workshop on relaxation techniques and stress control can be very beneficial. Supportive therapies Searching for information and wanting to learn more about dystonia without as a first step in the relationship with the disease. It is good also the support they can provide families, friends and others affected by the cramp. Support groups provide encouragement, a good environment and information on new treatments and the latest medical advances. In Catalonia ALDEC (Association of dystonia Lluita Against Catalunya) makes this work of supportive therapies. Edited by Dystonia Medical Research Foundation, One East Wacker Dr., Suite 2430, Chicago IL 60601-0905 - Prepared by Trevor Bass & Mark F. Gordon, MD, Dept. Of Neurology, Long Island Jewish Med Center, New Hyde Park NY. Reviewed by Mahlon R. Delong MD, Scientific Director DMRF. Translated by Roger Eritja Castilian. Supervised by Dr. Maria José Martí, the Hospital Clinic of Barcelona.


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