Functional writer's cramp as psychogenic focal dystonia
https://doi.org/10.14412/2074-2711-2022-1-115-121
Abstract
We present a description of a functional writer's cramp case. The disease manifested as pain and tension in the right hand when writing; thus, we suspected kinesigenic dystonia in the form of writer's cramp. However, the motor pattern and the presence of additional manifestations made it possible to assume the neurotic nature of hyperkinesis. A psychiatrist diagnosed a combined conversion motor and undifferentiated somatoform disorder as a part of personality dynamics of the dramatic cluster at the involutionary age. Treatment included cognitive-behavioral therapy and periciazine administration with a positive effect. We discuss the aspects of hyperkinesis and mental status, which help differentiate the kinesigenic form of dystonia (writer's cramp) and functional movement disorder.
About the Authors
V. A. TolmachevaRussian Federation
Department of Nervous System Diseases and Neurosurgery,
11, Rossolimo St., Build. 1, Moscow 119021
P. G. Yuzbashyan
Russian Federation
Department of Psychiatry and Psychosomatics, N.V. Sklifosovsky Institute of Clinical Medicine,
34, Kashirskoe Shosse, 115522 Moscow
R. M. Shishorin
Russian Federation
34, Kashirskoe Shosse, 115522 Moscow
B. A. Volel
Russian Federation
34, Kashirskoe Shosse, 115522 Moscow
D. V. Romanov
Russian Federation
34, Kashirskoe Shosse, 115522 Moscow
References
1. Jankovic J. Treatment of hyperkinetic movement disorders. Lancet Neurol. 2009 Sep;8(9):844-56. doi: 10.1016/S1474-4422(09)70183-8
2. Steeves TD, Day L, Dykeman J, et al. The prevalence of primary dystonia: a systematic review and meta-analysis. Mov Disord. 2012 Dec;27(14):1789-96. doi: 10.1002/mds.25244. Epub 2012 Oct 31.
3. Marsden CD. Dystonia: the spectrum of the disease. Res Publ Assoc Res Nerv Ment Dis. 1976;55:351-67.
4. Fahn S, Eldridge R. Definition of dystonia and classification of the dystonic states. Adv Neurol. 1976;14:1-5.
5. Mencacci NE, Reynolds RH, Garcia Ruiz S, et al. Dystonia genes functionally converge in specific neurons and share neurobiology with psychiatric disorders. Brain. 2020 Sep 1;143(9):2771-87. doi: 10.1093/brain/awaa217
6. Sohn HY, Hallett M. Disturbed surround inhibition in focal hand dystonia. Ann Neurol. 2004 Oct;56(4):595-9. doi: 10.1002/ana.20270
7. Nelson AJ, Hoque T, Gunraj C, et al. Impaired interhemispheric inhibition in writer's cramp. Neurology. 2010 Aug 3;75(5):441-7. doi: 10.1212/WNL.0b013e3181ebdda0
8. Nisticoo R, Pirritano D, Salsone M, et al. Blink reflex recovery cycle in patients with dystonic tremor: a cross-sectional study. Neurology. 2012;78:1363-5.
9. Nakashima K, Rothwell JC, Day BL, et al. Reciprocal inhibition in writer's and other occupational cramps and hemiparesis due to stroke. Brain. 1989;112:681-97.
10. Meunier S, Garnero L, Ducorps A, et al. Human brain mapping in dystonia reveals both endophenotypic traits and adaptive reorganization. Ann Neurol. 2001 Oct;50(4):521-7. doi: 10.1002/ana.1234
11. Molloy FM, Carr TD, Zeuner KE, et al. Abnormalities of spatial discrimination in focal and generalized dystonia. Brain. 2003 Oct;126(Pt 10):2175-82. doi: 10.1093/brain/awg219. Epub 2003 Jun 23.
12. Scontrini A, Conte A, Defazio G, et al. Somatosensory temporal discrimination in patients with primary focal dystonia. J Neurol Neurosurg Psychiatry. 2009 Dec;80(12):1315-9. doi: 10.1136/jnnp.2009.178236. Epub 2009 Jun 18.
13. Quartarone A, Bagnato S, Rizzo V, et al. Abnormal associative plasticity of the human motor cortex in writer's cramp. Brain. 2003 Dec;126(Pt 12):2586-96. doi: 10.1093/brain/awg273. Epub 2003 Sep 23.
14. Quartarone A, Rizzo V, Bagnato S, et al. Homeostatic-like plasticity of the primary motor hand area is impaired in focal hand dystonia. Brain. 2005 Aug;128(Pt 8):1943-50. doi: 10.1093/brain/awh527. Epub 2005 May 4.
15. Srivanitchapoom P, Shamim EA, Diomi P, et al. Differences in active range of motion measurements in the upper extremity of patients with writer's cramp compared with healthy controls. J Hand Ther. 2016 OctDec;29(4):489-95. doi: 10.1016/j.jht.2016.02.001. Epub 2016 Feb 18.
16. Hallett M. Pathophysiology of writer's cramp. Hum Mov Sci. 2006 Oct;25(4-5):454-63. doi: 10.1016/j.humov.2006.05.004. Epub 2006 Jul 21.
17. Farmer SF, Sheean GL, Mayston MJ, et al. Abnormal motor unit synchronization of antagonist muscles underlies pathological co-contraction in upper limb dystonia. Brain. 1998 May;121(Pt 5):801-14. doi: 10.1093/brain/121.5.801
18. Pekmezovic T, Svetel M, Ivanovic N, et al. Quality of life in patients with focal dystonia. Clin Neurol Neurosurg. 2009 Feb;111(2):161-4. doi: 10.1016/j.clineuro.2008.09.023. Epub 2008 Nov 7.
19. Hallett M, Benecke R, Blitzer A, Comella CL. Treatment of focal dystonias with botulinum neurotoxin. Toxicon. 2009 Oct;54(5):628-33. doi: 10.1016/j.toxicon.2008.12.008. Epub 2008 Dec 13.
20. Anandan C, Jankovic J. Botulinum Toxin in Movement Disorders: An Update. Toxins (Basel). 2021 Jan 8;13(1):42. doi: 10.3390/toxins13010042
21. Zeuner KE, Bara-Jimenez W, Noguchi PS, et al. Sensory training for patients with focal hand dystonia. Ann Neurol. 2002 May;51(5):593-8. doi: 10.1002/ana.10174
22. Park JE, Shamim EA, Panyakaew P, et al. Botulinum toxin and occupational therapy for Writer's cramp. Toxicon. 2019 Nov;169:12-7. doi: 10.1016/j.toxicon.2019.07.010. Epub 2019 Jul 24.
23. Orlova OR. Fokal’ny’e distonii: klinika, patogenez, lechenie s ispol`zovaniem toksina botulizma: Avtoref. dis. … dokt. med. nauk [Focal dystonia: clinical picture, pathogenesis, treatment with botulism toxin: Author's abstract. dis. ... doct. med. sciences]. Moscow; 2000. 48 p. (In Russ.).
24. LeDoux MS. The genetics of dystonias. Adv Genet. 2012;79:35-85. doi: 10.1016/B978-0-12-394395-8.00002-5
25. Baizabal-Carvallo JF, Hallett M, Jankovic J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol Dis. 2019 Jul;127:32-44. doi: 10.1016/j.nbd.2019.02.013. Epub 2019 Feb 21.
26. Stone J, Carson A. Movement disorders: Psychogenic movement disorders: what do neurologists do? Nat Rev Neurol. 2009 Aug;5(8):415-6. doi: 10.1038/nrneurol.2009.108
27. Smulevich AB. Psikhosomaticheskiye rasstroystva: rukovodstvo dlya prakticheskikh vrachey [Psychosomatic Disorders: A Guide for Practitioners]. Moscow: Med-press inform; 2019 (In Russ.).
28. Frucht L, Perez DL, Callahan J, et al. Functional Dystonia: Differentiation From Primary Dystonia and Multidisciplinary Treatments. Front Neurol. 2021 Feb 4;11:605262. doi: 10.3389/fneur.2020.605262. eCollection 2020.
29. Goldman JG. Writer's cramp. Toxicon. 2015 Dec 1;107(Pt A):98-104. doi: 10.1016/j.toxicon.2015.09.024. Epub 2015 Sep 21.
30. Ramos VF, Karp BI, Hallett M. Tricks in dystonia: ordering the complexity. J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):987-93. doi: 10.1136/jnnp-2013-306971. Epub 2014 Jan 31.
31. Schrag A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol. 2005 Aug;18(4):399-404. doi: 10.1097/01.wco.0000170241.86819.19
32. Smulevich AB. Borderline mental disorders. In: Tiganov AS, editor. Rukovodstvo po psikhiatrii [Psychiatric Guide]. Moscow: Medicine; 1999. Vol. 2. P. 527-607 (In Russ.).
33. Smulevich AB, Lvov AN, Iuzbashian PG, et al. Glossalgia as a psychodermatological syndrome. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021;121(7):7-13. doi: 10.17116/jnevro20211210717 (In Russ.).
34. Dubnitskaya EB, Volel BA, Serebryakova EV. Non-delusional hypochondria: history and current state of the problem (literature review). Psykhiatriya. 2008; (1): 44-54 (In Russ.).
35. Baturin KA, Yanshina TP, Trosnova AP, Dobrovolskiy AV. Somatic manifestations in involutional hysteria. Psikhicheskiye rasstroystva v obshchey meditsine. 2006;(1):23-7 (In Russ.).
36. Leahy R. Tekhniki kognitivnoy psikhoterapii [Techniques of cognitive psychotherapy]. St. Petersburg: Piter; 2020 (In Russ.).
37. Danilov DS. Periciazine “forgotten” by researchers and its significance for modern clinical practice. Psikhiatriya i psikhofarmakoterapiya = Psychiatry and Psichopharmacotherapy. 2015;17(1):31-7 (In Russ.).
38. Schmerler DA, Espay AJ. Functional dystonia. Handb Clin Neurol. 2016;139:235-45. doi: 10.1016/B978-0-12-801772-2.00020-5
39. Albanese A, Bhatia K, Bressman SB, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-73. doi: 10.1002/mds.25475. Epub 2013 May 6.
40. Morgante F, Edwards MJ, Espay AJ. Psychogenic movement disorders. Continuum (Minneap Minn). 2013 Oct;19(5 Movement Disorders):1383-96. doi: 10.1212/01.CON.0000436160.41071.79
41. Dallocchio C, Arbasino C, Klersy C, Marchioni E. The effects of physical activity on psychogenic movement disorders. Mov Disord. 2010 Mar 15;25(4):421-5. doi: 10.1002/mds.22952
42. Newby R, Alty J, Kempster P. Functional dystonia and the borderland between neurology and psychiatry: new concepts. Mov Disord. 2016 Dec;31(12):1777-84. doi: 10.1002/mds.26805. Epub 2016 Oct 18.
43. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry. 2014 Feb;85(2):220-6. doi: 10.1136/jnnp-2013-305321. Epub 2013 Sep 12.
44. Ibrahim NM, Martino D, van de Warrenburg BPC, et al. The prognosis of fixed dystonia: a follow-up study. Parkinsonism Relat Disord. 2009 Sep;15(8):592- 7. doi: 10.1016/j.parkreldis.2009.02.010. Epub 2009 May 12.
45. Thomas M, Vuong KD, Jankovic J. Longterm prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord. 2006 Sep;12(6):382-7. doi: 10.1016/j.parkreldis.2006.03.005. Epub 2006 Jun 5.
46. Gelauff J, Dreissen YEM, Tijssen MA, Stone J. Treatment of functional motor disorders. Curr Treat Options Neurol. 2014 Apr;16(4):286. doi: 10.1007/s11940-014-0286-5
Review
For citations:
Tolmacheva VA, Yuzbashyan PG, Shishorin RM, Volel BA, Romanov DV. Functional writer's cramp as psychogenic focal dystonia. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2022;14(1):115-121. https://doi.org/10.14412/2074-2711-2022-1-115-121