Resolved question:
Dear Sir, I am Naveen Kumar. I am asking a question on behalf of my daughter who is studying in class-XII. she is a good student, scoring above 99% in her XI th exam. But recently she has been complaining that in spite of knowing the answer of the question, she is not able to write & her hand does not move fluently & start paining and could not write further. During mar-apr this year there was no pain. Problem is more when she is writing some curvy alphabet e.g.- f,s etc. Her grip on the pen is with four fingers since childhood. and she has been writing till now with thinner grip pens. Is there any problems sir? What may be the reason for this and treatment.
I have shown to a Aurvedic doctor four days back, after examining he told that it is just due to lack of protein required by the brain. He prescribed neurobein tablet twice daily and vitamin D tablet one a week plus Protinex and high protein diet. But after three days of medication, there is not much improvement. What to do? Is there any serious problem? Need consultation from you.
Thanking you.
Submitted:
4 Days
Category:
Neurologist, Medical
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I have noted your daughter's symptoms.
The most likely cause for your daughter's difficulty in writing could be due to writer's cramp, a type of focal dystonia. This is caused by abnormal contraction of forearm muscles. An evaluation by a neurologist would confirm this and there are good treatments available for this condition.
In addition, we should also exclude associated anxiety.
I hope this helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,
Institute of Neurosciences,
Apollo Hospitals, Jubilee Hills,
Hyderabad- 500 033, India
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.
Thank you for getting back. If she is getting better, and the doctor feels it would be alright in 10 days, you can wait. You can continue the medications and exercises. If she does not recover in 10 days, you can show her to a neurologist. Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist.
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
Thank you for getting back.
MRI brain report is normal.
I agree with the opinion of your doctor Dr Mukesh Sharma of Apollo Hospitals, Ahmedabad.
I will suggest a good healthy diet, which has a lot of soyabean, pulses, and vegetables. Even dairy products are good sources of protein. Some exercises can be done to strengthen the hand muscles.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,
Institute of Neurosciences,
Apollo Hospitals, Jubilee Hills,
Hyderabad- 500 033, India
Phone: 91-040-23607777 (Office); 040-23540922 (Residence)
9866193953 (Mobile)
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.
Thank you for getting back.
Writer's cramp can be diagnosed by clinical examination of the patient while writing. No tests are available for that. MRI and blood tests will not detect writer's cramp. If I confirm the writer's cramp on clinical examination, I advise botox injection in the affected muscles.
No action is needed for a serum ceruloplasmin of 16. Just ask her to follow the diet as i mentioned and she will get better soon.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,
Institute of Neurosciences,
Apollo Hospitals, Jubilee Hills,
Hyderabad- 500 033, India
Phone: 91-040-23607777 (Office); 040-23540922 (Residence)
9866193953 (Mobile)
Website: http://members.tripod.com/sudhirkumar_5/neurologist/
Blog: http://bestneurodoctor.blogspot.com/