Examples of hand writing before and after successful treatment with botulinum toxin in three different patients with dystonic writer's cramp. Patient 1 could not write her own name and after treatment she was able to draw the letters in a more comfortable way and with improved posture. Patient 13 had intense spasms with clenching of the index and third fingers resulting in excessive slanting of the writing which was corrected after treatment. Patient 9 had serious difficulties in writing more than three to four lines because of intense muscle spasm producing pain in the forearm (see interruption in the fifth line of pre-treatment writing). After treatment her handwriting improved and was smoother, and she was able to write without experiencing prolonged muscle spasms.