Annals of Indian Academy of Neurology
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Year : 2015  |  Volume : 18  |  Issue : 2  |  Page : 146-153

A practical approach to management of focal hand dystonia


Department of Neurology, Room No. 507, Academic Block, Govind Ballabh Pant Hospital, New Delhi

Correspondence Address:
Sanjay Pandey
Department of Neurology, Room No. 507, Academic Block, Govind Ballabh Pant Hospital, New Delhi - 110002

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.156563

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Dystonia can be focal, segmental, multifocal, generalized, or hemidystonia. Focal dystonia is localized to a specific part of the body. Overall upper limb is more commonly involved in focal dystonia than lower limb and since it starts from hand, focal hand dystonia (FHD) is a more accepted terminology. Writer's cramp and musician dystonia are commonest types of FHD. Typically this dystonia is task specific, but in some patients this specificity may be lost over a period of time. Segmental or generalized dystonia may also start as FHD, so a detailed clinical assessment is required, which should be supplemented by relevant investigations. Treatment includes oral medications, injection botulinum toxin, neurosurgery including neurostimulation, and rehabilitation. Role of injection botulinum toxin has been extensively studied in writer's cramp patients and found to be effective; however, selection of muscles and techniques of injection are crucial in getting best results.


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