Cure of tremulous writer's cramp by stereotaxic thalamotomy. Case report.
Cure of tremulous writer's cramp by stereotaxic thalamotomy. Case report.
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立体定位丘脑切除术治疗颤抖作家痉挛。
DOI：
10.3171/jns.1969.30.2.0182
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发表时间：
1969
影响因子：
4.1
通讯作者：
E. Perret
中科院分区：
文献类型：
--
作者：
J. Siegfried;R. Crowell;E. Perret
从临床的观点来看，书写痉挛包括用钢笔或铅笔继续书写的严重困难。书写痉挛的发作可能是突然的，也可能是逐渐的，持续数年。书写困难是由握书写工具的手指痉挛或整只手痉挛引起的。前臂、上臂，甚至肩胛肱骨关节都可能发生痉挛。已经认识到该障碍的几种临床形式，并根据相关震颤的频率和特征进行分类。这些形式的书写痉挛指向一种器质性发病机制;尽管如此，一些作者认为是心因性的起源。由于一些患者在数年内发展成完全的帕金森综合征，书写痉挛也被认为是帕金森综合征的一种形式。然而，在大多数情况下，书写困难仍然是疾病的唯一表现。在过去，这种疾病的治疗一直是保守的，只有很少的例外。心理治疗和抗帕金森病药物已经尝试过，但没有太大的成功。我们提出一个震颤型书写痉挛的病例，在丘脑腹外侧核进行立体定位电凝治疗。这种手术治疗的成功使我们从一个新的角度来看待书写痉挛。
F ROM the clinical point of view, writer's cramp consists of severe difficulty in the continuation of writing with a pen or a pencil. The onset of writer's cramp may be either sudden or gradual, coming on over a period of years. The difficulty in writing is produced by a spasm of the fingers which hold the writing instrument or by spasm of the entire hand. The forearm, the upper arm, and even the scapulohumeral articulation may be involved in the spasm. Several clinical forms of the disturbance have been recognized, 3,4,6 and have been classified according to the frequency and character of the associated tremor. These forms of writer's cramp point to an organic pathogenesis; nonetheless, a number of authors have suggested a psychogenic origin. Since some patients develop a full-blown parkinsonian syndrome over a period of years, writer's cramp has also been thought to represent a forme fruste of parkinsonism. ~,2,4 In most cases, however, the writing difficulty persists as the only manifestation of disease. In the past, the treatment of this disorder has been conservative, with only rare exceptions. Psychotherapy and anti-parkinsonian drugs have been tried without much success. We are presenting a case of the tremulous type of writer's cramp treated by stereotaxic electrocoagulation in the nucleus ventralis lateralis of the thalamus. The success of this operative treatment leads us to regard writer's cramp from a new point of view.