Tremor and Other Hyperkinetic Movements

Abnormalities of Eye–Hand Coordination in Patients with Writer’s Cramp: Possible Role of the Cerebellum

Ketan Jhunjhunwala, Raviteja Kotikalapudi, Abhishek Lenka, Kandavel Thennarassu, Ravi Yadav, Jitender Saini, Pramod K. Pal

Abstract


Background: Writer’s cramp (WC) is one of the commonly observed focal dystonias. The pathophysiology of WC has not been fully understood. The role of the cerebellum has been increasingly recognized in the pathogenesis of dystonia. As the cerebellum is crucial for maintaining accurate eye–hand coordination (EHC), its role in the pathogenesis of WC can be investigated by studying the EHC in patients with WC.

Methods: Fifteen patients with WC (women:men, 3:12) and 15 age- and gender-matched controls performed oculomotor and EHC tasks. A visually guided stimulus (VGS) task was first performed with eye-only condition (EOC) and then with EHC.

Results: A significant interaction between the groups (controls and patients) and tasks (EOC and EHC) with age as a covariate confirmed that the two groups reacted differently to the tasks in saccadic latency (F(1,27) = 4.8; p = 0.039) and average saccade acceleration (F(1,27) = 10.6; p = 0.003). The curvature index of acceleration of the hand was significantly more in patients compared to controls (patients vs. controls, 2.4±0.4 vs. 1.8±0.2, p = 0.01). While performing the EHC task, there was a significant correlation of the Writer’s Cramp Rating Score with the average saccadic speed (–0.61, p = 0.016), peak saccadic deceleration (0.59, p = 0.019) and average saccadic acceleration (–0.63, p = 0.012).

Discussion: Saccadic acceleration and latency are abnormal while performing EHC tasks in patients with WC. Our study gives further insights into the possible role of the cerebellum in the pathogenesis of WC.


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