Introdução: A cãibra do escrivão (CE) é uma distonia focal com contração sustentada e involuntária das mãos, dedos e/ou braços durante a escrita. Poucos estudos avaliaram desempenho motor e cognição na CE a partir de testes neuropsicológicos. Os achados do estudo podem colaborar na reabilitação da doença. Objetivo: Avaliar os desempenhos motor e cognitivo dos pacientes com CE. Métodos: Foram avaliados 21 pacientes e 21 controles pareados por sexo e idade. Dados clínicos foram colhidos e combinados com avaliação da presença de sintomas de depressão, ansiedade e apatia por meio, respectivamente, dos Inventários de Depressão e Ansiedade de Beck e da Escala de Apatia. A gravidade da distonia foi quantificada pelas escalas Writer\'s Cramp Rating Scale e The Arm Dystonia Disabiliity Scale. O desempenho motor foi avaliado pelo Purdue Pegboard Test (PPT). Demais testes neuropsicológicos aplicados foram: Mini Exame do Estado Mental (MEEM), Frontal Assessment Battery (FAB), Symbol Digit Modalities Test (SDMT), Stroop Test (ST) e Trail Making Test (TMT). Resultados: Pacientes com CE apresentaram desempenho inferior aos controles nos testes: MEEM, FAB e ST parte \"W\". Após correção para anos de estudo, variável demográfica com diferença estatística significativa entre os grupos, manteve-se diferença significativa apenas na FAB. Pacientes apresentaram desempenho inferior aos controles nas tarefas com a mão dominante, com ambas as mãos e no teste de montagem do PPT. Após correção para variável anos de estudo, não houve diferença significativa, apenas tendência estatística à performance inferior de pacientes na tarefa montagem do PPT. O desempenho da tarefa montagem do PPT em pacientes com CE teve forte correlação positiva com testes neuropsicológicos, e não com gravidade motora da distonia. Conclusões: O estudo sugere que pacientes com CE apresentem disfunção executiva. As aterações motoras encontradas na tarefa montagem do PPT dos pacientes com CE estão possivelmente relacionadas ao déficit no funcionamento executivo destes indivíduos. / Introduction: The writer\'s cramp (WC) is a focal dystonia with sustained and involuntary contraction of the hands, fingers and/or arms during writing. Few studies have evaluated motor performance and cognition of these patients using neuropsychological tests. The findings may contribute to rehabilitation of this disease. Objective: evaluate motor and cognitive performance of patients with WC. Methods: Twenty-one patients and 21 matched controls by sex and age were evaluated. Clinical data were collected, with assessment of symptoms of depression, anxiety, and apathy using the respective clinical scales: Beck Depression Inventory, Beck Anxiety Inventory and Apathy Scale. Severity of dystonia was quantified by Writer\'s Cramp Rating Scale and The Arm Dystonia Disability Scale. Motor performance was assessed by Purdue Pegboard Test (PPT). Other neuropsychological tests applied were: Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Symbol Digit Modalities Test (SDMT), Stroop Test (ST) and Trail Making Test (TMT). Results: Patients with WC had inferior performance to the controls in MMSE, FAB and ST part \"W\". After correction for years of study, a demographic variable with significant statistical difference between the groups, a significant difference was maintained only in FAB. Patients had inferior performance to the controls in these tasks of PPT: task with the dominant hand, with both hands and in PPT assembly. After correction for the variable \'years of study\', there was no significant difference, only statistical tendency to inferior performance of patients in PPT assembly. The performance of PPT assembly task in patients with WC had a strong positive correlation with neuropsychological tests, and not with motor severity of dystonia. Conclusions: The study suggests that patients with WC have executive dysfunction. The motor alterations in patients with WC is possibly related to deficit in executive functioning

Introdução: A cãibra do escrivão (CE) é uma distonia focal com contração sustentada e involuntária das mãos, dedos e/ou braços durante a escrita. Poucos estudos avaliaram desempenho motor e cognição na CE a partir de testes neuropsicológicos. Os achados do estudo podem colaborar na reabilitação da doença. Objetivo: Avaliar os desempenhos motor e cognitivo dos pacientes com CE. Métodos: Foram avaliados 21 pacientes e 21 controles pareados por sexo e idade. Dados clínicos foram colhidos e combinados com avaliação da presença de sintomas de depressão, ansiedade e apatia por meio, respectivamente, dos Inventários de Depressão e Ansiedade de Beck e da Escala de Apatia. A gravidade da distonia foi quantificada pelas escalas Writer\'s Cramp Rating Scale e The Arm Dystonia Disabiliity Scale. O desempenho motor foi avaliado pelo Purdue Pegboard Test (PPT). Demais testes neuropsicológicos aplicados foram: Mini Exame do Estado Mental (MEEM), Frontal Assessment Battery (FAB), Symbol Digit Modalities Test (SDMT), Stroop Test (ST) e Trail Making Test (TMT). Resultados: Pacientes com CE apresentaram desempenho inferior aos controles nos testes: MEEM, FAB e ST parte \"W\". Após correção para anos de estudo, variável demográfica com diferença estatística significativa entre os grupos, manteve-se diferença significativa apenas na FAB. Pacientes apresentaram desempenho inferior aos controles nas tarefas com a mão dominante, com ambas as mãos e no teste de montagem do PPT. Após correção para variável anos de estudo, não houve diferença significativa, apenas tendência estatística à performance inferior de pacientes na tarefa montagem do PPT. O desempenho da tarefa montagem do PPT em pacientes com CE teve forte correlação positiva com testes neuropsicológicos, e não com gravidade motora da distonia. Conclusões: O estudo sugere que pacientes com CE apresentem disfunção executiva. As aterações motoras encontradas na tarefa montagem do PPT dos pacientes com CE estão possivelmente relacionadas ao déficit no funcionamento executivo destes indivíduos. / Introduction: The writer\'s cramp (WC) is a focal dystonia with sustained and involuntary contraction of the hands, fingers and/or arms during writing. Few studies have evaluated motor performance and cognition of these patients using neuropsychological tests. The findings may contribute to rehabilitation of this disease. Objective: evaluate motor and cognitive performance of patients with WC. Methods: Twenty-one patients and 21 matched controls by sex and age were evaluated. Clinical data were collected, with assessment of symptoms of depression, anxiety, and apathy using the respective clinical scales: Beck Depression Inventory, Beck Anxiety Inventory and Apathy Scale. Severity of dystonia was quantified by Writer\'s Cramp Rating Scale and The Arm Dystonia Disability Scale. Motor performance was assessed by Purdue Pegboard Test (PPT). Other neuropsychological tests applied were: Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Symbol Digit Modalities Test (SDMT), Stroop Test (ST) and Trail Making Test (TMT). Results: Patients with WC had inferior performance to the controls in MMSE, FAB and ST part \"W\". After correction for years of study, a demographic variable with significant statistical difference between the groups, a significant difference was maintained only in FAB. Patients had inferior performance to the controls in these tasks of PPT: task with the dominant hand, with both hands and in PPT assembly. After correction for the variable \'years of study\', there was no significant difference, only statistical tendency to inferior performance of patients in PPT assembly. The performance of PPT assembly task in patients with WC had a strong positive correlation with neuropsychological tests, and not with motor severity of dystonia. Conclusions: The study suggests that patients with WC have executive dysfunction. The motor alterations in patients with WC is possibly related to deficit in executive functioning

Dystonia is a neurological syndrome characterized by the involuntary contraction of opposing muscles, causing twisting movements or abnormal postures (modified by Fahn, 1987). Writer's cramp is the most common form of task-specific focal dystonia. In the first study, patients with writer's cramp were evaluated for differences in cortical activation during movements likely to induce cramps (complex movements) and movements which rarely lead to dystonia (simple movements). Although complex patient movements during fMRI were never associated with dystonic cramps, they exhibited abnormally decreased cortical activity. This was not observed in simple movements and was unrelated to the character of handwriting or the presence/absence of visual feedback. Our results support the theory of dualistic sensorimotor system behavior in writer's cramp. As the somatosensory system is believed to be affected in focal dystonia, we focused on modulation of the primary somatosensory cortex (SI) induced by repetitive transcranial magnetic stimulation (rTMS) in the second study, in order to improve writer's cramp. In conclusion, 1 Hz rTMS of the SI cortex can improve manifestations of writer's cramp while increasing cortical activity in both hemispheres. Handwriting as well as subjective assessment improved in most...

Dystonia is a neurological syndrome characterized by the involuntary contraction of opposing muscles, causing twisting movements or abnormal postures (modified by Fahn, 1987). Writer's cramp is the most common form of task-specific focal dystonia. In the first study, patients with writer's cramp were evaluated for differences in cortical activation during movements likely to induce cramps (complex movements) and movements which rarely lead to dystonia (simple movements). Although complex patient movements during fMRI were never associated with dystonic cramps, they exhibited abnormally decreased cortical activity. This was not observed in simple movements and was unrelated to the character of handwriting or the presence/absence of visual feedback. Our results support the theory of dualistic sensorimotor system behavior in writer's cramp. As the somatosensory system is believed to be affected in focal dystonia, we focused on modulation of the primary somatosensory cortex (SI) induced by repetitive transcranial magnetic stimulation (rTMS) in the second study, in order to improve writer's cramp. In conclusion, 1 Hz rTMS of the SI cortex can improve manifestations of writer's cramp while increasing cortical activity in both hemispheres. Handwriting as well as subjective assessment improved in most...