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Annals of Indian Academy of Neurology
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AIAN REVIEW
Year : 2021  |  Volume : 24  |  Issue : 3  |  Page : 319-326

Primary writing tremor: Current concepts


Maulana Azad Medical College, and Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India

Correspondence Address:
Prof. Sanjay Pandey
Department of Neurology, Academic Block, Room No 503, Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi - 110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_1264_20

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Primary Writing Tremor (PWT) is a type of task specific tremor which happens only while writing (Type A PWT) or assuming a writing position of the hand (Type B PWT). There is a considerable overlap of clinical features between PWT and writer's cramp which creates difficulty in diagnosing this condition in the clinic. PWT usually affects the dominant hand and is typically 5-7hz in frequency, worsened by anxiety, temporarily relieved by alcohol and associated with reduced writing speeds. There are a variety of hypotheses about the phenomenology of PWT (regarding whether it is a variant of essential tremor, focal dystonia or an independent entity). Unlike writer's cramp, PWT shows normal reciprocal inhibition of H reflex, does not exhibit excessive EMG activity in proximal muscles, and on fMRI shows underactivation of cingulum and overactivation of primary motor and supplementary areas. There are no randomised controlled trials currently for the treatment of PWT. Treatment modalities available are: medical treatment, botulinum toxin, surgical management (including DBS) as well as adaptive strategies and occupational therapy.


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