Micrographia is an acquired disorder characterized by abnormally small, cramped

handwriting Handwriting in Italian schools (XXth - XXIst century) Handwriting is the personal and unique style of writing with a writing instrument, such as a pen or pencil in the hand. Handwriting includes both block and cursive styles and is separa ...

. It is commonly associated with neurodegenerative disorders of the

basal ganglia The basal ganglia (BG) or basal nuclei are a group of subcortical Nucleus (neuroanatomy), nuclei found in the brains of vertebrates. In humans and other primates, differences exist, primarily in the division of the globus pallidus into externa ...

, such as in

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...

, but it has also been ascribed to subcortical focal lesions. O'Sullivan and Schmitz describe it as an abnormally small handwriting that is difficult to read, as seen in the accompanying photo. Micrographia is also seen in patients with

Wilson's disease Wilson's disease (also called hepatolenticular degeneration) is a genetic disorder characterized by the excess build-up of copper in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, wea ...

obsessive compulsive disorder Obsession may refer to: Psychology * Celebrity worship syndrome, obsessive addictive disorder to a celebrity's personal and professional life * Obsession (psychology), a persistent attachment to an object or idea * Fixation (psychology), persi ...

metamorphopsia Metamorphopsia (from , ) is a type of distorted vision in which a grid of straight lines appears wavy or partially blank. In addition, metamorphopsia can result in misperceptions of an object's size, shape, or distance to the viewer. People can f ...

, or with isolated focal lesions of the

midbrain The midbrain or mesencephalon is the uppermost portion of the brainstem connecting the diencephalon and cerebrum with the pons. It consists of the cerebral peduncles, tegmentum, and tectum. It is functionally associated with vision, hearing, mo ...

or basal ganglia.

Parkinson's disease

A common feature of

(PD) is difficulty in routine activities due to lack of motor control. Patients have trouble maintaining the scale of movements and have reduced amplitude of movement (

hypokinesia Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a sy ...

). In PD, the trouble in scaling and controlling the amplitude of movement affects complex, sequential movements, so that micrographia is a common symptom. Another cause of micrographia is lack of physical

dexterity Fine motor skill (or dexterity) is the coordination of small muscles in movement with the eyes, hands and fingers. The complex levels of manual dexterity that humans exhibit can be related to the nervous system. Fine motor skills aid in the growt ...

James Parkinson James Parkinson (11 April 1755 – 21 December 1824) was an English surgeon, apothecary, geologist, palaeontologist and political activist. He is best known for his 1817 work ''An Essay on the Shaking Palsy'', in which he was the first to desc ...

may have been aware of micrographia in patients with shaking palsy (later renamed Parkinson's disease), when he described "the hand failing to answer with exactness to the dictates of the will".

Occurrence in Parkinson's

Micrographia is often seen amongst patients with Parkinson’s disease, although the precise prevalence is uncertain, with reported figures of between 9% and 75%. Often appearing before other symptoms, it can help in diagnosis.

Pharmacological management

Micrographia may worsen when a PD patient is under-medicated and when the medication is wearing off.

References

Bibliography

* {{DEFAULTSORT:Micrographia (Handwriting) Penmanship Parkinson's disease