Dear Sir, Thanks for answering. After four days of above medication, the pain in her wrist is subsidised. But after writing some lines, her grip on the pen becomes loose and she is unable to write further. What I want to know is whether the above medication along with exercise is OK or further diagnosis is required? The doctor to whom I had shown her, is telling it will take around ten days to recover. In your opinion what should I do? One more thing I must mention that when she writes with chalk on blackboard, she is OK but the problem occurs with the pen. Thanks.

Dear Sir, I have shown my daughter to a neurologist. He advised for a MRI & a blood test. The report of the same is pasted below. In your opinion what is the abnormality? Here the doctor says it is just lack of protein. Need your guidance. Thanks.
Name SOUMYA SINGH UHID no. 253556 Referred By MUKESH SHARMA / SUCHETA MUDGERIKAR Age/sex 16/Female MRI BRAIN PLAIN FINDINGS: : Technique:T2, FLAIR, GRE axial, T1 sagittal & DWI Axial. FINDINGS: Brain parenchyma shows normal signal intensity on all sequences. Sulcal and gyral pattern appear normal. No surface collection. Ventricles and basal cisterns appear normal. Deep grey matter nucleus appear normal. Brainstem and cerebellum appear normal. No mass effect / midline shift. Sella and parasellar region appear normal. Major flow voids are preserved. Imaged portion of orbit and paranasal sinuses appear normal. IMPRESSION: Normal study. CERULOPLASMIN (COPPER OXIDASE) - SERUM Investigation Result Unit Range Serum Ceruloplasmin 16.1 mg/dl 20-60 SGPT [ALT] - SERUM Investigation Result Unit Range SGPT / ALT 18 U/L 0-31 PERIPHERAL SMEAR FOR OPINION[PBF] Note: This is a representative electronic report of the lab results. Kindly contact the hospital for the final lab test report. Page 1 www.apolloprism.com Peripheral Smear Study : RBCs: Normocytic normochromic Acanthocytes are not seen. WBCs: As mentioned DC:N:52,L:42,M:03,E:03,B:00. Platelets: 293000 and normal in morphology. No parasites are identified in the smear examined.. Note: This is a representative electronic report of the lab results. Kindly contact the hospital for the final lab test report. Page 2 www.apolloprism.com

Dear Sir,
Thanks for quick reply. Earliar you had suspected this case to be a writer's cramp, a type of focal dystonia. Had it been detected in the above two clinical tests? Or some other clinical test is also required?
Secondly, Serum Ceruloplasmin is 16.1 mg/dl range 20-60. What does this show, can this also be a problem, as it is below the range?
By going through the above lab reports, you still believe it as a case of writer's cramp.
Any medication would you like to prescribe.
Thanks and waiting for your reply as my daughter is in tension as her study is being hampered.