LAUSR

We read with interest the report by Ganguly et al, regarding a case with pattern-specific dysgraphia. This case is important as it expands the limited spectrum of reports pertaining to the domain of difficulties in grapheme generation, particularly related to probable abnormalities in effector specific motor programs. The case by Ganguly et al, describes an individual with dysgraphia predominantly while writing Bengali and restricted to letters which required initiation with a circular loop. This is similar to our reported case who incidentally also had a predominant difficulty with Bengali script with dysgraphia restricted to a single letter with a circular loop at initiation. This report with its similarities and variations from our case, implores us to ask a myriad of pertinent questions which are associated with linguistics, writing systems and the anatomy of graphemes. A standard grapheme is formed of multiple segments such as the bud, knot, stem, dot, etc. It is imperative to understand that the style of writing has a significant bearing on the reported abnormality. The video provided by Ganguly et al, demonstrates that their case wrote the majority of the letters with a predominant initial bud whereas our case only wrote a single letter with the bud. Perhaps if our case had a different handwriting, we might have observed pattern rather than letter specificity. This suggests the possible need to elicit the pattern specificity by making the patient write in a different style. Another important question is why the two reports of this nature are related to Bengali script. This language is part of the Indic/Brahmic group of scripts, and almost all included languages have a similar structure for graphemes. It is rather perplexing that there are no reports from other languages, which have more buds, knots and loop. The patient in the case by Ganguly et al, had difficulty while writing the letter “c” in English and this was not due to default presence of a bud in the letter, rather due to his style of writing the letter. This fact once again highlights the role of the pattern in grapheme generation. However, it would be interesting to know if a forcible change in handwriting or if writing with a different body part such as the foot would alter the dysgraphia. The underlying abnormality is considered to be the effector specific motor program that encodes the muscle activation pattern for each grapheme. This is perhaps a valid reason for a single letter but is uncertain if the same can hold true for abnormality in a specific pattern which is present across multiple graphemes. Finally, the most pertinent question is why the initial loop, ie, the bud or knot? Why not another aspect of the grapheme, or toward the middle or the end. Although there are no clear answers to any of these questions, and this may not particularly be a disabling disability, it is an intriguing field to explore which deserves further evaluation in future reports.