Treatment

Treatment is generally disappointing.

General measures

The person should avoid the specific precipitating activity as far as is possible. Where writing is the problem, alternative techniques such as altering the size and diameter of the pen, the type of pen, the method of gripping the pen or the position of the arm may help. Some individuals are able to develop use of the non-dominant hand to carry out the task. However, in some cases alternative forms of transcription such as typing or dictation may be the only alternative. Where typing or use of a keyboard is the specific cause then changes in technique or type of keyboard may help but the use of voice-activated software may be needed.

Training in the correct use of equipment and education to help avoid risks of damage from poor technique may help to prevent the condition developing or allow the individual to return to work.

Drug treatment

Several types of drug treatment are used to reduce spasm and tremor:

• Anticholinergic drugs such as Trihexyphenidyl (Artane) and Amantadine block the effect of acetylcholine on the basal ganglia of the brain and increase the effect of nerve transmitters that reduce spasm.
• Beta adrenergic blocking drugs such as Propanolol may help to reduce the effects of tremor associated with the spasm.
• Nerve toxins such as Botulinum toxin type A (Botox) given by local intramuscular injections weaken overactive muscles and reduce dystonic symptoms. This procedure must be done by a specialist in the technique.

The response to drug treatment is often unreliable but Botulinum toxin seems to be the most effective.

Psychotherapy

Counselling or behavioural therapy sometimes helps the individual to come to terms with the condition and modify lifestyle to avoid difficulties. Biofeedback, hypnotherapy and relaxation therapy may also be helpful.