Primary writing tremor. A form of focal dystonia?
Article first published online: 12 OCT 2004
Copyright © 1990 Movement Disorder Society
Volume 5, Issue 2, pages 118–126, 1990
How to Cite
Elble, R. J., Moody, C. and Higgins, C. (1990), Primary writing tremor. A form of focal dystonia?. Mov. Disord., 5: 118–126. doi: 10.1002/mds.870050205
- Issue published online: 12 OCT 2004
- Article first published online: 12 OCT 2004
- Writer's cramp;
- Primary writing tremor
Five patients exhibited severe tremor in the upper extremity, primarily when attempting to write or draw. Electromyography was performed to determine the patterns of muscle activity that were responsible for this tremor. Tremor was measured with an accelerometer and with a digitizing tablet. Two patients had postural tremor that was indistinguishable from mild, high-frequency essential tremor. All patients exhibited a severe 5–7-Hz tremor during the acts of writing and drawing. Muscles throughout the affected extremity exhibited rhythmic 5–7-Hz bursts of motor unit discharge, and the average level of motor unit activity was tonically increased in antagonistic muscles. This abnormal coactivation of antagonistic muscles produced subtle dystonic posturing of the affected limb that was overshadowed by severe tremor. Electromyography was useful in confirming the coexistence of tremor and dystonia in our patients. The nonspecificity of dystonia and postural tremor must be considered when discussing the nosology and pathophysiology of primary writing tremor.