Clinical Cases

Focal Hand Dystonia (FHD) in a Man of 62

Dystonia hands

Dr. Shahnwaj Ahmad presents a case of focal hand dystonia in a 62 year old male patient. Trembling of right hand while writing only and profuse salivation while asleep were symptoms that led to the correct remedy.

A 62 year old male patient (OPD No.- 138535/17) came to NIH OPD from Barasat, West Bengal on 17 April 2017 with these complaints:

  • Trembling of right hand while writing only, causing difficulty in writing since 3years.
  • Pain in right deltoid region since 3years. Agg. by raising the right upper limb.
  • Difficulty in breathing on and off since 15 years. < exertion, smoking, > sitting

History of presenting complaints:

Patient was apparently well 3years back, then he gradually suffered from trembling of hand only while writing. Complaint is progressively increasing. One year back, 2-3 episodes of dizziness and trembling. He had taken allopathic medicines for few days.

Past history:

  • Right eye cataract operation 15-16 years back.
  • Mumps and typhoid in childhood.
  • Intestinal worms 25 years back.

Family history: nothing significant.

Personal history:

  • Smoking, 20 bidi/day, started 16-17years of age.
  • Diet- non-veg.

Physical generals –

  • Appetite- good
  • Thirst- 2-3 L/day
  • Desires – sweet, warm food, spicy, oily food
  • Tongue- moist, clean
  • Salivation- profuse in sleep
  • Perspiration- on scalp eating while, on back, chest.
  • Thermal reaction- chilly patient

Mental generals –

Mild, avoids fighting.

Company desires, controls his anger, amelioration from consolation

Systemic examination –

Wheezing on bilateral upper chest

Investigation findings:

  • CT Scan head (09/01/16) : subtentorial focal ischemic changes along bilateral ant. subcortical centrum semiovale and right post. temparo-parietal lobe. Mild age related neuro-degeneration.
  • 20/04/17- triglyceride- 200mg/dl.
  • 18/04/17 – Hb- 11.7gm%

Provisional diagnosis:

  • Focal hand dystonia
  • COPD
  • Frozen shoulder

Totality of symptoms:

  • Company desire
  • Desire- sweet, warm food
  • Perspiration- on scalp eating while.
  • Salivation sleep during
  • Increased salivation
  • Chilly patient
  • Trembling of hand while writing.
  • Difficulty in breathing, exertion after.

Repertorization through “Synthesis 9.1 using  RADAR 10 Homoeopathic software.

Patient was admitted in NIH IPD male ward and physiotherapy was advised. After complete case taking, the following medicines were prescribed.

First prescription on 17/04/17 : Merc- sol 200 one dose.

Second prescription on 20/04/17 : Merc- sol 1M one dose.

I prescribed Merc-sol after considering the whole case and consulting materia medica. This patient had a prominent presenting feature of hand tremor while writing only. I further considered profuse salivation while asleep, which was also  prominent in the case.

Follow up:

After prescribing the Merc-sol, patient showed continuous improvement in:

  • Cough and difficulty in breathing
  • Pain in right deltoid region improved
  • Much improvement in trembling of hand while writing

Focal hand dystonia (FHD) causes involuntary movement, cramps or tremor in the hand or arm muscles, usually when making highly practiced hand movements such as writing or playing a musical instrument. Focal hand dystonia is often called writer’s cramp or musician’s cramp. FHD pathogenesis includes putative mechanisms including loss of inhibition, sensorimotor abnormalities, and maladaptive plasticity.  There is no one isolated cause and it is said that there is no cure for dystonia.

This case shows the beauty of homoeopathy, a complete scientific and artistic method of therapeutics which demands individualisation and totality of symptoms for selection of the medicine. Disease diagnosis has a very limited role in selection of homoeopathic medicines. In homeopathy, for a case having different disease conditions, different medicines are not prescribed, but single homoeopathic medicine are given which cover the disturbance of the whole person to establish a complete cure in a gentle and permanent way.

About the author

Shahnwaz Ahmad

Dr. Shahnwaj Ahmad - 16TH Batch PGT, Session- 2014-17 -Department of Case taking and Repertory - National Institute of Homoeopathy (NIH), Kolkata

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