Therapeutic and neurophysiological effects of immobilisation followed by motor training in writer´s cramp

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Writers's cramp (WC) is a task-specific dystonia characterized by involuntary cocontractions during handwriting. So far treatment options for WC are limited. Recent studies have suggested that immobilization or specific motor training of the dystonic limb may be effective in task-specific dystonia. Therefore, the aim of this research proposal is to evaluate the therapeutic effects of immobilization and sensorimotor training of individualized finger movements in WC. Our prediction is that limb immobilization followed by specific training will potentiate and prolong the therapeutic effect as opposed to immobilization alone. The study will include twenty-four patients with WC, which will be randomly assigned to two interventions: (i.) immobilization of the writing hand in a splint for four weeks or (ii.) immobilization of the writing hand followed by specific sensorimotor training. Improvement in handwriting will be the primary outcome measure, which will be assessed both clinically in a blinded fashion and kinematically with a handwriting analysis program. In addition, we will assess dystonia-related sensorimotor dysfunction with transcranial magnetic stimulation and functional brain imaging (EEG and fMRI) before, during and after treatment. This will help to closely link neurophysiologic abnormalities and dystonic symptoms and will provide a framework to guide future treatment strategies for task-specific dystonia.