Increased writing activity in neurological disease

A neurophenomenological fMRI study of a spontaneous automatic writer and a hypnotic cohort

PURPOSE

To evaluate the neurophenomenology of automatic writing (AW) in a spontaneous automatic writer (NN) and four high hypnotizables (HH).

METHODS

During fMRI, NN and the HH were cued to perform spontaneous (NN) or induced (HH) AW, and a comparison task of copying complex symbols, and to rate their experience of control and agency.

RESULTS

Compared to copying, for all participants AW was associated with less sense of control and agency and decreased BOLD signal responses in brain regions implicated in the sense of agency (left premotor cortex and insula, right premotor cortex, and supplemental motor area), and increased BOLD signal responses in the left and right temporoparietal junctions and the occipital lobes. During AW, the HH differed from NN in widespread BOLD decreases across the brain and increases in frontal and parietal regions.

CONCLUSIONS

Spontaneous and induced AW had similar effects on agency, but only partly overlapping effects on cortical activity.

Analysis of writing in an epilepsy center population: a prospective blinded study

Sixty adult comprehensive epilepsy center patients were given a simple writing task to complete. The essays were scored using four unique scales: Subject--whether the writing concentrated on physical or emotional aspects of the seizures; Focus-how much of the essay was on task; Ratio--a measure of detail; Word--total word count. Among the findings, patients with nonepileptic events (n=28) tended to write essays containing both physical and emotional components (P=0.058), whereas those with partial seizures (n=28) did not (P=0.006). Essays concentrating on emotional aspects increased the likelihood of a diagnosis of partial seizures (P=0.059). The variance of Ratio was higher in those without nonepileptic events than in those with nonepileptic events (P=0.0003), whereas it was higher in the group with partial seizures than in the group without partial seizures (P=0.000008). This study suggests unique features associated with the writing of patients with epilepsy and those with nonepileptic events.

Increased writing activity in Parkinson's disease: a punding-like behavior?

We report a 32-year-old male patient with early-onset Parkinson's disease who exhibited abnormally increased writing activity. The patient displayed a disabling and pronounced increased writing activity, filling up to 10 pages or more per day in a notebook, and spending more than 12 h writing. In general, there was not much meaning in most of the writing, though there was a particular preference in tabulating the names of various sport and TV personalities. The writing activity gradually diminished following treatment with quetiapine hydrochloride, an anti-psychotic agent, at 25 mg/day. Although the pathophysiological mechanism underlying the increased writing is unclear, we believe it should be regarded as a form of punding or stereotyped behavior that has been suggested to be associated with dopaminergic therapy in Parkinson's disease.