Albert Schweitzer: a patient with writer's cramp

Efficacy and safety of botulinum toxin-A in writer’s cramp: a systematic review, meta-analysis, and meta-regression

Background

Botulinum toxin-A (BoNT) reduce over-firing of dystonic muscles, spasmodic contractions by enhancing function. We conducted a systematic review and random-effects meta-regression to investigate the efficacy and safety of BoNT in writer’s cramp (WC). Published electronic articles from inception till January 2022 were screened from four databases (Medline, Science Direct, Scopus, ProQuest). Effect sizes in the form of standardized mean differences were calculated for estimation of efficacy.

Results

Nineteen studies [six randomized control trials (RCTs) and 13 observational studies] involved 587 (514 experimental; 73 Controls) participants with mean age of 43.46 ± 8.84 years with mean duration of WC of 8.31 ± 5.35 years. Injection did not result in significant improvement in writing speed [standard mean difference (95% CI) 0.06 (− 0.35, 0.46)]. There was no significant difference in writing speed as compared to controls [standard mean difference (95% CI) − 0.51 (− 2.55, 1.52)]. The meta-analysis of observational studies showed a significant difference in the mean WC rating score [standard mean difference (95% CI) 0.54 (0.20, 0.88)]. Pooled analysis (observational studies and RCTs) demonstrated a significant difference in the mean Writer’s cramp rating score (WCRS) after BoNT [standard mean difference (95% CI) 0.75 (0.06, 1.44)]. No major safety concerns were reported in the included studies.

Conclusions

According to the meta-analysis of observational studies, BoNT injections are effective in WC for improving WCRS without major safety concerns. However, according to the meta-analysis of RCTs, there was no significant effect in efficacy with BoNT.