Writing spasms, also known as primary writing tremor, are the most common form of motor tremor in adults, and are most common when the tremor occurs during writing, making writing difficult. It is more common clinically and refers to a 5-8 Hz hand tremor that occurs when the patient is writing or doing writing actions without other dysfunction. Some patients have tremor that is not limited to writing actions, but can also have tremor when doing other similar tasks or using similar tools. Epidemiology: No relevant incidence statistics have been found. The onset of the disease is insidious, slow and gradual, and occurs mainly in people aged 20-50 years who have been engaged in writing for a long time. Etiology: Writing spasm syndrome is mostly a neurological disorder, but some scholars believe that it is an extrapyramidal disorder or a sympathetic reflex disorder. Pathogenesis: Hypertonia is the most common, the hand and wrist muscles spasm when writing; or because of muscle weakness can not use the pen at will, similar to a state of paralysis; there are also hyperkinetic type, writing hand and wrist muscle tremor, and gradually increase mental tension is more obvious as a result of active muscle and antagonist muscle disorder. Clinical manifestations: Writing spasm syndrome This disease mainly occurs in people aged 20-50 years who have been engaged in writing for a long time, especially those who are engaged in writing, some patients have a positive family history Most patients have a slow and gradual onset of the disease Most patients feel easy fatigue in the fingers or wrist pain, followed by a characteristic writing spasm Patients have difficulty in holding a pen or starting to write This spasm phenomenon occurs mainly in the fingers, wrists and even the entire upper limb The most important feature of this disease is that the spasm does not occur when writing. The most important feature of this disease is that the spasm disappears when writing and not writing. The muscle strength is completely normal, sometimes only with pens or small pens alone, and completely normal with pencils or large pens. The patient can work normally without loss of use. The disease is mostly a neurological functional disorder, but in some cases, a high interphalangeal or wrist muscle tone can be seen during the examination. Clinically, writing spasm can be divided into three types: 1, spastic type (hypertonic type) is the most common type of writing quickly cause hand muscle wrist muscle spasm or alternating contraction state. 2, paralysis type (weak type) patients write with a sense of fatigue and weakness, because the muscle force is weak can not be arbitrarily dominated similar to the state of paralysis and can not use the pen, and sometimes pain along the nerve line. 3, tremor type (hyperkinetic type) can be seen when writing hand shaking tremor, with writing tremor gradually increased, especially under the influence of mental tension and more significant this performance is the result of active muscle and antagonist muscle disorder. Diagnostic criteria: 1. All patients have hand tremor, which leads to difficulty in writing and can occur with the skilled work of the (left or right) hand and the use of tools, but to a lesser extent. 2, physical examination found that not only in writing but also in keeping the hand in this position have tremor upper extremity still have non-specific action tremor amplitude than writing tremor 3, according to the hand tremor appears in different situations can be divided into two types of primary writing tremor limited to writing tremor, called task-induced type; writing and keeping the writing posture have tremor, called posture-sensitive type. Exclusion criteria: 1. Abnormal involuntary postural manifestations such as dystonia posture. 2, there is clinical evidence of dystonia or other manifestations of neurological disorders, such as Parkinson’s syndrome. Differential diagnosis: It is generally believed that primary writing spasm is a variant of idiopathic tremor because the frequency of tremor is similar between the two, and primary writing tremor is also associated with mild postural or motor tremor of the upper extremities. Primary writing spasms, especially the task-induced type, usually remain relatively stable and remain confined to hand tremor, whereas primary writing tremor is also considered a variant of writing spasms, both of which are task-specific and to some extent also exhibit coarse tremor. The age of onset of writing spasms is 10-20 years younger than that of primary writing tremor. Tests: Laboratory tests: blood electrolytes, drugs, trace elements and biochemical tests, which can help in differential diagnosis. Other auxiliary examinations: 1. CT, MRI examination is meaningful for differential diagnosis of intracranial diseases. 2.Electromyography is meaningful for differential diagnosis. 3.Gene analysis is important to identify some hereditary dystonia diseases. Treatment: Some patients with writing spasms can improve their symptoms after drinking alcohol. About 1/2 of the patients can reduce their symptoms by taking Prenalol and Clonazepam, and starting with small doses and gradually increasing them to effective control doses. Local injection of botulinum toxin type A is also effective. Prevention: 1. After working continuously for a period of time, let the hands rest for a moment; or suspend the work of fine manipulation with hands, and change the type of work to dry, in order to let the hands get rest. Strengthen physical exercise, targeted exercise is to play fitness ball daily, has the effect of unblocking the hands qi and blood, enhance the function of arm muscles, regulate the function of the cerebral cortex. 2, there is a “hand not from the heart” spasm symptoms, can be eliminated through self-massage symptoms. With the left hand small fissure massage the right hand and forearm; also can be used in the left middle finger or thumb point to join the valley, Quchi, Waiguan points, each point point pressed 2 minutes, feel a sense of soreness and swelling can be. You can also acupuncture Fengchi, Baihui, Hegu, Quchi, Waiguan, Neiguan, and Feisanli points, each point for 15 minutes each time, 1-2 times a day. After these activation of blood, circulation, antispasmodic self-treatment, the symptoms will be eliminated more quickly. 3, with the hands do not forget to protect the hands, often do hands health massage, not only to care for hands, but also to strengthen the body. Massage the heart of the hand has the effect of dredging the meridians and the qi nimble heart. The specific method is: first with both hands palm fast friction 30-50 times, to be hot palm, with the right hand palm to the left hand forearm inside from the end of the fingers to the elbow repeatedly push the rubbing 50-100 times. Then rub the hot palm, in the same way with the left palm push rub the right hand. Do this l times a day in the morning and evening. In addition, rubbing the thumb has the role of stimulating the cerebral cortex; massage the index finger can regulate the function of the digestive system, strengthen the spleen and stomach, liver and bile; massage the middle finger can prevent cardiovascular disease; massage the ring finger can adjust the function of the nervous system, improve its sensitivity; massage the little finger can enhance the function of the respiratory system and genitourinary system, to prevent upper respiratory tract infections. The friction between the back of the hands can stimulate the head, neck, shoulders, eyes, nose, back of the human body, the treatment of eye fatigue, shoulder and back pain has a certain role.