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

书写痉挛（WC）是一种任务特异性肌张力障碍，其特征是书写过程中的不自主共同收缩。到目前为止，WC的治疗选择有限。最近的研究表明，肌张力障碍肢体的固定或特定的运动训练可能对任务特异性肌张力障碍有效。因此，本研究的目的是评估固定和感觉运动训练的个性化手指运动在WC的治疗效果。我们的预测是，肢体固定后的具体训练将加强和延长治疗效果，而不是固定单独。本研究将纳入24名WC患者，将其随机分配至两种干预措施：（i.）将书写手固定在夹板中四周或（ii.）固定书写手，然后进行特定的感觉运动训练。笔迹改善将是主要结局指标，将以盲法进行临床评估，并使用笔迹分析程序进行运动学评估。此外，我们将在治疗前、治疗中和治疗后通过经颅磁刺激和功能性脑成像（EEG和fMRI）评估肌张力障碍相关的感觉运动功能障碍。这将有助于密切联系神经生理异常和肌张力障碍症状，并将提供一个框架，以指导未来的治疗策略，为任务特异性肌张力障碍。

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.