Obsessive-compulsive characteristics in patients with writer's cramp

Writer's cramp is characterised by a muscular spasm in the hand of the writing arm, and is often provoked during specific tasks such as writing. Because of its highly task specific nature, some neurologists believed that writer's cramp was of psychogenic origin. However, recent electrophysiological and neuroimaging studies unanimously confirmed basal ganglia dysfunction in patients with writer's cramp. As a consequence, writer's cramp is currently regarded as a form of focal dystonia with neurophysiological pathogenetic mechanisms.1 On the other hand, in the classic psychiatric literature, clinicians sporadically pointed out obsessive-compulsive personalities in patients with writer's cramp. Bindman and Tibbetts described 10 patients with writer's cramp, nine of whom had obsessional personalities.2 These findings have never been confirmed using reliable psychometric measures. However, because of the above mentioned evidence of basal ganglia pathophysiology in writer's cramp, together with the growing evidence of basal ganglia involvement in obsessive-compulsive disorder, it is of great interest to elucidate the relation between writer's cramp and obsessive-compulsive symptoms. In the present study, we evaluated obsessive-compulsive symptoms in patients with writer's cramp. Obsessive-compulsive symptoms may simply be a psychological reaction to the writing impairment. To rule out this possibility, patients with writing impairment due to peripheral …