Objective: We aim to explore the non-motor features of WC patients and correlate those with motor symptoms. 

Background: Writer’s cramp (WC) is essentially a motor disorder, involving the basal ganglia and its connections. It is well known that Non-motor symptoms (NMS) are coexisting features in a number of movement disorders involving basal ganglia. But NMS are not well documented in cases of WC.  

Methods: Patients attending the outpatient department of a tertiary care neurology referral centre in the eastern part of India were recruited, who presented with writing difficulty and diagnosed as writer’s cramp by neurologist.  Individual patients were thoroughly assessed through various motor (DASH, WCRS, ADDS) and non motor (MINI, MOCA, GAD7, PHQ9, OCI, SF36) scales. Audio visual recording of uniform writing tasks were performed for all patients. 

Results: 30 consecutive patients with WC were recruited. Interestingly, all of them were male. The mean age of the patients was 54.83 years (SD 10.77). Mean disease duration for this cohort was 72.36 months.  The average motor disability of the patients was 18.4% of maximum possible disability (DASH score). 70% and 60% patients reported Generalized Anxiety Disorder (GAD) and Major Depressive Episodes (MDE) respectively in recent past. 50% had Obsessive Compulsive Disorder (OCD) with a mean OCI score of 2.22 (maximum mean score 4). Panic disorder and social phobia were present among 26.7% and 60% respectively. Out of 18 patients suffering from social phobia, 12 were phobic specific to writing tasks in public.95.2% patients with GAD and MDE had moderate to severe grade of anxiety and depression respectively.  Cognitive impairment was present in 25 (83.3%) WC patients.  DASH score is negatively correlated with total MOCA score and attention score. 

Conclusions: Anxiety, depression, social phobia and OCD are four most frequent non motor symptoms present in WC patients. Functional disability in WC is proportional to the cognitive impairment and attention tasks. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-in-patients-with-writers-cramp/