title: Stereotactic neurosurgery for writer's cramp: report of two cases with an overview of the literature.
abstract: BACKGROUND
  Writer's cramp is a specific movement disorder with hand muscle cramps in writing, being classified into focal and action-specific dystonia. Stereotactic surgery, such as thalamotomy and deep brain stimulation (DBS), has been reported for writer's cramp; however, the number of reported cases is still scarce and surgical procedures are also controversial.
  
  
  OBJECTIVE
  In this study, therefore, we present 2 patients who underwent thalamotomy for writer's cramp and systematically review the literature on stereotactic surgery for writer's cramp.
  
  
  METHODS
  Case reports and literature review are presented.
  
  
  RESULTS
  Both patients underwent ventral oral nucleus (Vo) thalamotomy safely. Their symptoms completely disappeared after surgery and did not recur during follow-up periods. In the literature, a total of 31 cases were surgically treated for writer's cramp. Stereotactic surgery included thalamotomy in 25 cases and DBS in 6. The target included the Vo in 17 cases, the ventral intermediate nucleus (Vim) in 3, and both Vo and Vim in 7. Both procedures markedly improved or resolved the symptoms. Transient neurological deficits were observed in 16.0% of patients after thalamotomy.
  
  
  CONCLUSIONS
  The Vo may be the most effective target to treat writer's cramp. Both thalamotomy and DBS are feasible and effective, but thalamotomy would be a better option, especially in younger or high-risk patients.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahi
authors.forename: Masaki
authors.initials: M
authors.lastname: Koh
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
mesh_terms: D020821:Dystonic Disorders / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult