Bleton Jean-Pierre, Touzé Emmanuel, Soulez-la-Rivière Laure, Baizabal-Carvallo José Fidel, Guignier Françoise, Cambriel Claire, Sangla Sophie, Grabli David, Roze Emmanuel, Mesure Serge, Vidailhet Marie
INSERM U894 Centre Psychiatrie-Neurosciences Hôpital Sainte-Anne Université Paris Descartes Paris France.
Aix-Marseille Université-CNRS Institut des Sciences du Mouvement, UMR 7287 Marseille France.
Mov Disord Clin Pract. 2015 Mar 30;2(3):232-236. doi: 10.1002/mdc3.12153. eCollection 2015 Sep.
The effectiveness of retraining therapy (RT) for writer's cramp is difficult to predict and its determinants are unknown. We examined factors potentially predicting improved legibility after RT in patients with writer's cramp (WC). We reviewed the files of 693 WC patients treated with RT from 1995 to 2009. Standardized assessments were made both at baseline and after 2 months of RT in 305 patients. The effect of RT on legibility was evaluated by using the handwriting subscore of the Burke-Fahn-Marsden (BFM) disability scale. Initial and final handwriting samples were blindly scored in random order. Associations between WC patterns and changes in legibility were identified by uni- and multivariable analyses. Legibility improved by ≥1 point in the BFM handwriting subscore in 93 patients (31%). WC patients who improved were more likely to have synergic dystonic patterns involving the wrist and forearm (60% vs. 40%; = 0.03) and less likely to have flexion of fingers F3 to F5 (19% vs. 81%; = 0.017). Outcome was not related to gender, age, or dystonia duration. Our results confirm that retraining therapy could improve legibility in patients with writer's cramp. The pattern of writer's cramp can help to identify patients who are most likely to benefit from retraining therapy, regardless of age, gender, and disease duration.
再训练疗法（RT）对书写痉挛的疗效难以预测，其决定因素也尚不清楚。我们研究了可能预测书写痉挛（WC）患者接受RT后字迹清晰度改善的因素。我们回顾了1995年至2009年接受RT治疗的693例WC患者的病历。对305例患者在基线时和RT治疗2个月后进行了标准化评估。使用伯克 - 法恩 - 马斯登（BFM）残疾量表的笔迹子评分来评估RT对字迹清晰度的影响。初始和最终的笔迹样本按随机顺序进行盲评。通过单变量和多变量分析确定WC模式与字迹清晰度变化之间的关联。93例患者（31%）的BFM笔迹子评分中字迹清晰度提高了≥1分。病情改善的WC患者更有可能出现涉及手腕和前臂的协同性肌张力障碍模式（60%对40%；P = 0.03），而手指F3至F5屈曲的可能性较小（19%对81%；P = 0.017）。结果与性别、年龄或肌张力障碍持续时间无关。我们的结果证实，再训练疗法可以改善书写痉挛患者的字迹清晰度。书写痉挛的模式有助于识别最有可能从再训练疗法中获益的患者，而与年龄、性别和病程无关。
