Background: Writer’s cramp is a very rare in pediatric population, few case reports were seen scarcely on writer’s cramp. Primary writer’s cramp in children is not yet to be reported in medical literature. Here in we reported 4 cases of writer’s cramp with earliest age of onset. Our aim was to focus on early detection, proper evaluation and management of writer’s cramp to ensure better quality of life of an affected child.

Methodology: The patients reported in this study were seen in outpatient department of Pediatric Neurology, National Institute of Neurosciences and Hospital from june2017-March 2018. Every patient was evaluated through history, physical examination and investigation. Ophthalmological evaluation, Neuroimaging, urinary cu, serum ceruloplasmin, metabolic screening was done to find out underlying pathology. Genetic testing was done in affordable cases. All patients were treated with anti-dystonic drugs and their outcome was assessed after 1 month.

Result: Among 4 cases mean age was 8.3 years and M: F ratio was 3:1. Flexor dystonia was found in 3 cases. One boy had extensor dystonia. All of them had normal ophthalmological, hematological, biochemical, genetic and neuroimaging findings except 1 case (focal cortico-subcortical hyperintensity in both parietal regions). Mild improvement was found in 3 cases after 1 month.

Conclusion: Childhood dystonia can result in lifelong disability and thus represents a significant diagnostic and rehabilitation challenge. A detailed clinical evaluation and comprehensive work-up to rule out treatable causes of focal dystonia are mandatory for establishing a therapeutic strategy.