Patient: Hello, I just graduated from high school now, and 8 months ago I got a strange disease – difficulty writing with my right hand. I practiced for a month yesterday summer and my handwriting did get better. But in September, my hand was not right, and my writing was crooked, but at that time I could still write up and go. So far this condition is getting worse and more difficult, the general situation is as follows (right hand): 1, writing for a few minutes in a row after the wrist has a kind of outward arching feeling, think the hand is skewed (Sichuan) up, as to the hand joints misaligned like, thumb and tiger mouth turned out. 2, writing muscles are tight and tense, especially hard, the muscles are seriously shrunken back, feel the tendons are pulled, twisted, such as writing the number 3, the middle can not bend, are written into 1. 3, there is a long time hand numbness, ring finger, pinky finger and the right side of the palm of that piece, the night day numb wake up, but now it is better. 4.Writing trembles, the word is not neatly written, no one can read. I have finished the college entrance examination, to be honest, although my performance is not particularly good, but the examination is not a problem. This time, especially in the language and literature exams, I knew exactly what to answer, but because of my difficulty in writing, I didn’t finish many questions, so I did poorly in the exam. I almost cried in the examination room, if I am not good at studying, playful, stupid exams, even if, but I worked very hard in the first and second year of high school, but the result was such a result… I also saw a doctor, in May my father took me to the best psychiatric hospital in Mianyang, Sichuan to have an MRI of the head, and the head was found to be fine. I also had two more MRI’s in the cervical spine and they were still normal. I went to the best central hospital and had an electromyogram done, which was also normal. Went to see a psychiatrist, but I’ve never been very cheerful. I took VB1 and VB12, potassium cobalamin, and even some Chinese medicine for tendon constriction, but to no avail. The strangest thing is that I have no problem doing other things, such as serving tea, playing basketball, and pulling a bar, but I have difficulty writing. Is this writing spasm? Can your hospital do the surgery? How much will it cost? Jin Lingjing, Department of Neurology, Shanghai Tongji Hospital Jin Lingjing, Department of Neurology, Shanghai Tongji Hospital: Your description is very clear and logical, and you have typed so many words, which means that your problem is mainly in writing, right? From what you said, we should indeed consider writing spasms first, but we still need to know in detail whether you have any family history, the onset of the disease, whether the symptoms fluctuate during the day, whether there are other findings in the neurological examination, and whether you have taken any special medication food, etc., to exclude relatively rare diseases such as dopa-responsive dystonia and atypical manifestations of the cause (if possible, try low-dose levodopa treatment). If other diseases are ruled out, I suggest that the first treatment option you consider trying is highly selective intra-arm botulinum toxin injections, which should be able to control the symptoms in most patients after 1-2 adjustments to the regimen. I hope my advice will be helpful to you, keep in touch. Patient: Sorry, I had eye surgery a while ago and couldn’t get online, so I just asked you today …. Our tertiary hospital there said it is self-healing and untreatable. I want to go to Shanghai or Beijing, but my father said there is something wrong with me and told me to see a psychiatrist… He said that since I had three MRI’s, my skull and cervical spine are fine, my EMG is normal, and my muscles are not atrophied, so it must be my mind… The first thing you need to do is to get a good idea of what you’re talking about. Also, is there a hospital in Chengdu that has a method for injecting Botox? Jin Lingjing, Department of Neurology, Shanghai Tongji Hospital: If it is written spasticity head MRI generally has no abnormal findings, mainly relying on clinical manifestations, to exclude other diseases after diagnosis. I am not sure if Chengdu hospital carries out this treatment, you may need to go to the local consultation.