Writing by a Parkinson's disease patient

Micrographia is an acquired disorder that features abnormally small, cramped

handwriting Handwriting is the writing done with a writing instrument, such as a pen or pencil, in the hand. Handwriting includes both printing and cursive styles and is separate from formal calligraphy or typeface A typeface (or font family) is ...

or the progression to progressively smaller handwriting. It is commonly associated with neurodegenerative disorders of the

basal ganglia The basal ganglia (BG), or basal nuclei, are a group of subcortical nuclei, of varied origin, in the brains of vertebrates. In humans, and some primates, there are some differences, mainly in the division of the globus pallidus into an extern ...

, such as in

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...

, 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 photo to the right. Micrographia is also seen in patients with

Wilson's disease Wilson's disease is a genetic disorder in which excess copper builds up in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, weakness, fluid build up in the abdomen, swelling of the legs, ...

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

Metamorphopsia Metamorphopsia (from , ) is a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank. People can first notice they suffer with the condition when looking at mini-blinds in their home. For examp ...

, or with isolated focal lesions of the

midbrain The midbrain or mesencephalon is the forward-most portion of the brainstem and is associated with vision, hearing, motor control, sleep and wakefulness, arousal ( alertness), and temperature regulation. The name comes from the Greek ''mesos'', " ...

or basal ganglia.

Parkinson's disease

A common feature of

(PD) is difficulty in routine activities due to lack of motor control. More specifically, patients have difficulty maintaining the scale of movements and have reduced amplitude of movement; also known as

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 ...

. These difficulties with scaling and controlling the amplitude of movement cause patients with PD to have difficulty with complex, sequential movements. This helps to explain why micrographia is a common symptom of the disease. Another reason is a 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 grow ...

James Parkinson James Parkinson (11 April 175521 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 describe ...

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 patients with Parkinson’s disease, although the precise prevalence is uncertain, with reported figures of between 9% and 75%. It often appears before other symptoms, so is potentially useful in diagnosis.

Pharmacological management

Micrographia may worsen when a PD patient is under-medicated or when the effects of the medication are wearing off.

References

Bibliography

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