OBJECTIVE: To assess the utility of handwriting rehabilitation (HR) in Parkinson disease (PD) patients who experienced difficulties with handwriting and signing. METHODS: Sixty PD patients were prospectively studied with graphological evaluations. Thirty PD patients were assigned to HR for 9 weeks. At the end of this training, all patients were evaluated again and results of basal vs. final evaluations were compared. RESULTS: At final evaluation, the group assigned to HR showed significantly larger amplitude of the first 'e' in the phrase, larger signature surface area, and superior margin. A trend of increase in letter size was also observed. Handwriting with progressively decreasing size of letters and ascending direction with respect to the horizontal were prominent findings in both groups of patients and they did not change after HR. CONCLUSION: Rehabilitation programs for handwriting problems in PD patients are likely to be helpful. Larger randomized studies are needed to confirm these results.
Handwriting* ; Humans ; Parkinson Disease* ; Pilot Projects* ; Prospective Studies ; Rehabilitation*

Primary writing tremor is considered to be a task-specific tremor occurring when handwriting. We describe the clinical and electrophysiological features of 5 patients. Two of the patients had a family history of the tremor. Alcohol was effective in reducing the tremor in 3 of the patients. Two patients showed a co-contraction and three alternate contractions between agonist and antagonist muscles. The frequency of the tremors was 5 to 6 Hz. Primidone and propranolol were effective in reducing tremor. Considering the clinical and electrophysiological features, it is suggested that primary writing tremor might be a variant of essential tremor. (J Korean Neurol Assoc 19(1):52~55, 2001
Essential Tremor ; Handwriting ; Humans ; Muscles ; Primidone ; Propranolol ; Tremor* ; Writing*

OBJECTIVE: Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. METHODS: From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. RESULTS: Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. CONCLUSION: GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures.
Brain ; Comorbidity ; Follow-Up Studies ; Handwriting ; Humans ; Magnetic Resonance Imaging ; Movement Disorders ; Thalamus ; Tremor*

Writer's cramp is one of the most frequent type of task-related dystonia. It is primarily defined by the appearance of involuntary muscle contractions soon after one begins to write and often co-exists with postural tremor. The cause of writer's cramp as well as other focal dystonia is still a matter of debate. Although the genetic background of some dys-tonia was well known, there have been few cases of writer's cramp that involve other family members. We experienced one family with writer's cramp and postural tremor. A 42-year-old man noted handwriting difficulty of gradual onset which began with postural tremor at the age of 25. When he wrote certain letters or numbers, he automatically had to press hard or hold the pen tightly, experiencing tremor as well as dystonia. His mother and four siblings also had simi-lar disabilities. All were right-handed, and had a postural tremor, prominent in their right hands. They noted the onset of symptoms between the age of 20 and 40. The symptoms had slowly progressed over a period of years and no patient described a remission of symptoms. Two of them eventually no longer attempted to write due to writer's cramp. Two members could write but barely readable and the other two had minimal distress. Alcohol somewhat relieved the cramp in only one of them. Levodopa was no beneficial to the cramp and baclofen relieved the cramp minimally. We report this rare case with familial writer's cramp and postural tremor that suggests autosomal dominant inheritance.
Adult ; Baclofen ; Dystonia ; Dystonic Disorders* ; Hand ; Handwriting ; Humans ; Levodopa ; Mothers ; Muscle Cramp ; Muscle, Smooth ; Siblings ; Tremor ; Wills

Adult ; Autonomic Nerve Block ; Cerebrovascular Disorders ; drug therapy ; Disability Evaluation ; Handwriting ; Hemiplegia ; drug therapy ; Humans ; Male ; Methods ; Middle Aged ; Stellate Ganglion

The standard radical neck dissection, introduced at the turn of the 20th century, became the uniformly-accepted treatment of cervical metastatic disease through the 1960s. Functional or modified radical neck dissection was developed in the 1950s and 1960s. This procedure became the accepted treatment for suitable tumors by the 1970s. Now, the concept of selective neck dissection, removal of only the node levels likely to be involved with tumor, gained acceptance by the late 1980s as a definitive elective, and eventually, therapeutic neck dissection for suitable cases. In response to the increasing variations of neck dissection procedures, a number of classification systems were proposed and subsequently established. The system of the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery was revised in 2002 and 2008. The neck dissections are grouped into four broad categories: radical, modified radical, selective, and extended neck dissection. The Japan Neck Dissection Study Group presented a new system for the classification of neck dissections based on a system of letters and symbols. The system permits a comprehensive and shorthand method of precise designation of neck dissection procedure, but has the disadvantage of departing radically from previously employed systems, by utilizing an entirely new terminology and designation of lymph node groups. In 2011, an international group proposed a classification which conveys precisely the extent of the lymphatic and non-lymphatic structures removed in a neck dissection. So they contended it is logical, simple, and easy to remember, and prevents possible confusion associated with the ambiguous terminology previously mentioned. And they also maintained it allows the recording of neck dissection procedures that cannot be classified under the existing systems. In 2012, the American Thyroid Association proposed the consensus of lateral neck dissection in DTC. They defined again that a selective neck dissection refers to removal of less than all five nodal levels directed by the patterns of lymphatic drainage from the primary tumor while preserving CN XI, IJV, and SCM. And they also insist that selective neck dissection is the most commonly-used neck dissection in the management of lateral neck metastasis for thyroid cancer, and should be reported with a designation of the side and nodal levels and sublevels dissected (i.e. selective neck dissection of levels IIa, III, IV, and Vb). But most classification systems have some limitations and disadvantages to describe the exact procedures of lymphatic and non-lymphatic structure resection. It is a necessary component of a new systemic classification and nomenclature system for neck dissection, not only because the method of describing operative procedures must be unified to allow comparisons of therapeutic methods, but also because of the need to customize therapies individually. A new neck dissection classification system in thyroid cancer has to overcome all these limitations and will facilitate communication around the world with reliable reporting and comparison of outcomes among different surgeons and institutions.
Classification* ; Consensus ; Drainage ; Head ; Japan ; Logic ; Lymph Nodes ; Methods ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Shorthand ; Surgeons ; Surgical Procedures, Operative ; Thyroid Gland* ; Thyroid Neoplasms*