Micrography is a change in the nature of handwriting with a tendency to reduce the size of letters. In micrographic writing, all letters are written equally small (less than 3 mm), or their height gradually decreases towards the end of the line, which makes the handwritten test quite difficult to read. This symptom is most typical for Parkinson's disease, secondary parkinsonism. Micrography is also found in patients with dysgraphia, macropsia, and manic-depressive syndrome. In order to establish a nosological diagnosis, cerebral CT or MRI, transcranial sonography, and neuropsychological testing are performed. Treatment is predominantly medical, psychotherapeutic.
The handwriting of students with optical dysgraphia can be both small, “beady”, and large, sweeping. Due to the mismatch in the coordination of the visual and motor analyzers, letters often turn out to be of different sizes, “dance” on the line, crawl out of its borders, and constantly “creep” down. In addition to problems with handwriting, there are difficulties with the correct display of graphic symbols: underwriting or rewriting of elements, replacement of letters, mirror writing.
Micrography is a pathognomonic sign of trembling paralysis, which appears already in the early stages of the disease. Parkinson's disease (PD) is characterized by general stiffness of movements, hypokinesia, and trembling of the extremities. In the tremor form of PD, the tremor is most pronounced in the hands, which significantly changes the patient's handwriting: the lines of graphic symbols acquire an uneven, jagged, "oscillating" appearance.
With a rigid form, the letters are small, too close to each other. Sometimes at the beginning of a line the letters are of normal size, but towards the end of the line they become smaller and more illegible, reminiscent of scribbles. The writing process slows down. In advanced stages, the ability to write is completely lost.
Along with changes in handwriting by the type of micrography, oral speech also undergoes changes. The general speech activity decreases, the patient answers questions in monosyllables. The voice becomes almost silent, trembling, fading. With the interest of the articulatory muscles, dysarthria develops, making the speech statement even more slurred.
micrography
The phenomenon of micrography is also observed in various types of symptomatic parkinsonism: drug-induced, vascular, toxic, postencephalic, etc. Against the background of damage to the basal structures of the brain, there is a slowdown in the speed and a decrease in the amplitude of movements, including fine motor skills of the hand. Patients begin to have difficulty performing precise movements: tying shoelaces, fastening buttons, brushing their teeth.
Habitual activities become difficult to perform, such as playing musical instruments, working at a computer, writing. Patients write in a small, compact ("beaded") handwriting, the spaces between words and between lines are also reduced. The excursion of hand movements gradually decreases, so the manner of writing can be called "fading". In the advanced stages of secondary parkinsonism, handwriting becomes completely incomprehensible.
With macropsia, the perception of surrounding objects is disturbed: they seem larger than their actual size, and the person himself feels small and helpless against their background. This phenomenon is called the Alice in Wonderland syndrome. It can be observed with migraine, complex forms of epilepsy, brain tumors, taking hallucinogenic drugs.
The letters also seem too large to the writer, so the patient tries to display them as small as possible. Attacks of macropsia are usually transient, lasting up to several days, less often weeks, so micrography in this disorder is also unstable.
In the manic stage of bipolar disorder, macrography, carelessness, and sloppy writing are noted. In the depressive stage, the nature of handwriting and writing changes. There is a reduction in the line spacing (the phenomenon of "increasing convergence of lines"), a decrease in the size of letters towards the end of a line or page (micrography). Typically misspelled words.
The cause of micrography in some patients may be uncorrected myopia. In this case, a person places a sheet of paper at a close distance from the eyes, writes small and neat. However, the peculiarities of vision of a near-sighted person also allow him to write in larger handwriting, with large spaces between words. Therefore, micrography cannot be considered a defining characteristic of myopic refraction.
The medical literature also describes other disorders characterized by changes in handwriting, including micrography. However, small writing in these cases is not mandatory, but only an acceptable "attribute". These diseases include:
Since micrography is mainly observed in the framework of neurological and psychiatric syndromes, patients require a neuropsychiatric examination with the involvement of appropriate specialists. Additionally, you may need to consult an ophthalmologist. For the diagnosis is carried out:
True micrography must be differentiated from the characterological features of handwriting that occur in healthy people. In graphology, it is believed that compact small handwriting is characteristic of people who are restrained in emotions, closed, pedantic, purposeful.
Rehabilitation for movement disorders
There is no specially developed treatment for micrography; handwriting change can be achieved in the course of therapy for the underlying disease. The standard pharmacotherapy for Parkinson's disease and symptomatic parkinsonism is with dopaminomimetics, which improve motor function. With secondary parkinsonism, detoxification therapy, vascular, neurometabolic agents can also be prescribed.
For the treatment of bipolar disorder, mood stabilizers, antidepressants, antipsychotics are used. With metamorphopsia, a differentiated approach is practiced, aimed at eliminating the root cause (antiepileptic, antiviral, antitumor therapy).
Patients with motor disorders that cause micrography are recommended physiotherapy exercises, kinesiotherapy, occupational therapy, biofeedback therapy. For violations of expressive speech and dysgraphia, classes with a speech therapist may be required. If the patient is susceptible to depressive moods, psychotherapeutic assistance (interpersonal, cognitive-behavioral, family psychotherapy, compliance therapy) is necessary.
With myopia, hygiene of vision, a decrease in visual stress are shown. Regular intake of vitamins and nootropics, courses of physiotherapy (laser therapy, color pulse therapy, magnetotherapy), SHVZ massage, acupuncture are recommended. Compensation of visual function is carried out with the help of contact lenses or glasses. If desired, it is possible to perform laser vision correction using the LASIK, Super LASIK, Femto LASIK, PRK methods.