Abstract Details

Title Pilot trial of botulinum toxin and occupational therapy for Writer’s Cramp

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-019

Objective

We aimed to compare the effects of botulinum toxin (BoNT) therapy alone with a combination of BoNT and occupational therapy on patients with writer’s cramp as measured by a patient-rated subjective scale.

Background

Writer’s cramp (WC) is a form of focal hand dystonia, for which focal BoNT injections are the current best therapy. Past studies have shown that some types of rehabilitative therapy can be useful. We hypothesized that BoNT and occupational therapy together would be better than BoNT alone for treating WC patients.

Design/Methods

Twelve WC patients were randomized to two groups. 6 received only BoNT therapy and 6 received BoNT therapy and occupational therapy. The occupational therapy involved specific exercises of finger movements in the direction opposite to the patient’s dystonic movements during the writing task. The primary outcome was the patient-rated subjective scale at 20 weeks. Secondary outcomes were assessed by four blinded video-raters using several scales (the writer’s cramp rating scale: WCRS, writer’s cramp impairment scale: WCIS, and the writer’s cramp disability scale: WCDS).

Results

The patient-rated subjective scale scores at 20 weeks were not significantly different between the two treatment groups. Repeated measures ANOVA showed that there was a significant interaction between time (visit 1 and visit 8) and group (BoNT and BoNT+OT) (P<0.05) for both WCIS and WCRS. The decrease in WCIS (from 25 to 18) was found to be significant in the BoNT+OT group. For other secondary outcome measures (WCDS, handgrip, and spiral error), there were no significant differences.

Conclusions

The patient-rated subjective scale scores at 20 weeks were not significantly different between the two groups. However, WCIS scores were significantly improved with combination therapy compared with BoNT alone. Our study findings are limited by a small sample size. Therefore, further study of occupational therapy methods to improve the efficacy of BoNT seem worthwhile.

Authors/Disclosures
Jung E Park, MD, PhD (Dongguk University Ilsan Hospital) PRESENTER	No disclosure on file
Ejaz Shamim, MD, MS, MBA, FAAN (MAPMG)	The institution of Dr. Shamim has received research support from Michael J. Fox Foundation.
Pattamon Panyakaew, MD (Chulalongkorn Parkinson Center)	No disclosure on file
Camilo Toro, MD, FAAN (NIH)	Dr. Toro has received personal compensation in the range of $100,000-$499,999 for serving as a TORO with NIH/IRP.
Jonathan J. Sackett (National Institute of Neurological Disorders and Stroke)	No disclosure on file
	No disclosure on file
Barbara P. Karp, MD, FAAN	Dr. Karp has nothing to disclose.
Codrin I. Lungu, MD, FAAN	Dr. Lungu has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, inc..
Katharine Alter, MD (National Institutes of Health)	Katharine Alter, MD has received personal compensation for serving as an employee of Paradigm Medical Communications. Katharine Alter, MD has received personal compensation for serving as an employee of Cleveland clinic foundation. Katharine Alter, MD has received personal compensation for serving as an employee of Catalyst medical . Katharine Alter, MD has received personal compensation for serving as an employee of AANEM. Katharine Alter, MD has received personal compensation for serving as an employee of Efficiwent CME. Katharine Alter, MD has received publishing royalties from a publication relating to health care.
	No disclosure on file
Tianxia Wu	Tianxia Wu has nothing to disclose.
	No disclosure on file
	No disclosure on file
Mark Hallett, MD, FAAN (National Institutes of Health)	Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Hallett has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainsway. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for VoxNeuro. Dr. Hallett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for QuantalX. Dr. Hallett has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Hallett has received intellectual property interests from a discovery or technology relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Speaker with International Parkinson and Movement Disorder Society. Dr. Hallett has a non-compensated relationship as a Past-President with Functional Neurological Disorder Society that is relevant to AAN interests or activities.

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