Randevu 0216 449 09 41
Prof. Dr. Cengiz BAHADIR

Dystonia (Writer’s Cramp – Musician’s Cramp)

Transcranial Magnetic Stimulation (TMS) treatment for Dystonia (writer’s cramp, musician’s cramp) patients

Dystonia is simply involuntary, uncontrolled muscle contractions in a region of the body. There is a harmony between the muscles in our body. For example, when you twist your wrist, the muscles that make this movement contract, while the muscles lifting the wrist are loosening. We would not be able to do the simplest movements smoothly if there was no harmony between these opposing muscles that we call the antagonist. In dystonia, due to the involuntary muscle contractions this harmony is damaged and the movements are difficult to control. These muscle contractions cause spine curvature disorders, bendings and repetitive movements.
Due to these involuntary contractions in certain muscle groups that sometimes occur spontaneously during certain movements, dystonia patients experience serious difficulties in daily home – work activities. This also affects their social lives considerably. Dystonia is actually not muscle disease but a disease occurring in central nervous system that controls muscles. This disease has an unknown origin. It can be inherited or acquired later. There are many types of dystonia. The most well-known of these is the disorder that is called writer’s cramp or musician’s cramp. Especially in professionals from occupation groups where wrist and finger movements are repetitive, dystonia development is possible. In these people, after a while, involuntary contractions occur in the muscles running the wrists and fingers. This leads to contractions in opposing muscle groups which should loosen while these movements. For example, a writer’s hand-writing can deteriorate or she/he cannot write anymore , or a musician cannot play any intrument anymore properly.


Another form of dystonia is cervical dystonia or spasmodic torticollis. People with this disorder have movements such as involuntary neck movements, tilting the head to one side and turning the neck. Similar clinical results may be seen due to psychogenic diseases. Congenital cerebral palsy is another case where dystonia is seen. In these cases, dystonia may progress in a way that it affects the whole body.
Although there are many patients of dystonia, an effective systemic drug treatment has not been developed yet. However, it is possible to receive good results from local treatments. One of the primary local treatments is local botulinum toxin (botox) injections. Botulinum toxin is a very strong bacterial toxin and is one of the world’s most powerful poison. This toxin affects muscle junction and creates a slight paralysis in muscle. The muscle where botox is applied loses its movement capability for while. By this way, contractions occurred during movement is prevented substantially. This effect reaches peak level in 5th week of treatment and its effect continues 3 or 4 months. The most important handicaps of this treatment are not being effective in some patients, losing effect after a period of the applications and the necessity to continue the injection with 3-4 month intervals.

distoni1Transcranial magnetc stimulation treatment has become a new hope for patients of dystonia. TMS treatment is based on stimulation of brain with magnetic field. It is implemented with a special device by stimulating desired regions of brain with magnetic energy through a magnetic coil.. By adjusting the frequency of stimulation given by TMS, the activity of nerve cells in the desired brain region can be inhibited or increased. Thus, TMS has become a promising alternative treatment for incurable brain diseases. In dystonia patients, some regions of brain have uncontrolled increase of activity. For these patients, related regions of brain may be suppressed with a low-frequency magnetic stimulation. In dystonia patients, TMS is applied to region called motor cortex of opposing hemisphere of affected hand. First, a quick test called motor threshold stimulation is applied to determine current intensity. This threshold is specific to each patient. In this test, movement center of brain is stimulated and, hand and finger muscles’ movements are recorded. According to current intensity determined by this test, appropriate treatment dosing is planned. TMS treatment is usually applied daily and 1200 stimulation is given in every session. Generally this treatment continue 10 days but there might be changes in treatment protocols. TMS treatment gives successful results in some patients with writer’s cramp (musician’s cramp) or cervical dystonia (spasmodic torticollis). Since TMS treatments are applied within the safety limits, there is nearly no side effects. The healing effect of TMS treatment continues even after a long period of time.
TMS treatment has been successfully used in the treatment of dystonia as in other brain diseases in recent years. TMS treatment with newly developed protocols seems to be most important treatment alternative for fight against dystonia in near future.