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Neurology (Expert Forum)
GVHD and occupational dystonia
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GVHD and occupational dystonia
by Claudio-Calegarini, Apr 22, 1997 12:00AM
Re: GVHD and occupational dystonia
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Posted by CCF Neuro MD on April 28, 1997 at 16:03:30:
In Reply to: GVHD and occupational dystonia posted by Claudio Callegarini on April 22, 1997 at 14:29:25:
: I'm an italian neurologist and I have a 25 years hold patient that is suffering from a focal occupational dystonia as writer's cramp: he's an electrician and this kind of disease is very irritating for him. The peculiarity of the case is the following: this patient one year ago was successfully bone marrow transplanted owing to a chronic myeloid leukaemia.
Now, these symptoms don't respond to any therapies (anticholinergic drugs associated with clonazepam was the last try). Do you know similar cases ? Can we suspect some kind of chronic graft versus host disease in a isolated dystonic form ? I would like to specify that NMR was negative an that the patient wasn't suffering from any form of tetany (EMG and blood tests and were negative). Can you prompt me anything? Thank you very much.
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Hello Dr Callegarini,
This a very interesting problem that you have described. I must admit that I have never seean a patient or heard of any asociation with GVHD and writer's cramp (or dystonia.) I did an extensive literature search on this subject and failed to come across any reported cases of with such as association. I did come across many reports of neurologic disorders with bone marrow transplantation including metabolic encephalopathy, CNS infections, stroke, side effects from medication etc. There was no reported CNS involvement from GVHD. There were a number of reported cases of cyclosporin causing cramps but they did not specify to the best of my knowledge if there were any patients who specifically had writer's cramp. Although this disorder is thought to be a dystonia, it is conceivable that this may still be lumped under the term cramps in these reports. It is possible that your patient may benefit from botox injections for symptomatic relief if this has not already been tried. Thank you for sharing your
interesting observations.
