Musikerdystonien

Botulinum toxin (BoTX) is the standard treatment for task-specific dystonias (TSDs) such as musician’s dystonia (MD). Our aim was to assess the long-term changes in BoTX treatment in a highly homogeneous and, to our knowledge, largest group of MD patients with respect to the following parameters: (1) absolute and (2) relative BoTX dosage, (3) number of treated muscles, and (4) inter-injection interval. We retrospectively assessed a treatment period of 20 years in 233 patients, who had received a cumulative dose of 68,540 MU of BoTX in 1819 treatment sessions, performed by two neurologists. Nonlinear correlation was used to analyze changes in the parameters over the course of repeated treatments. Post-hoc we applied a median-split to classify two subgroups (high-BoTX, low-BoTX) depending on the total amount of BoTX needed during treatment. Across all patients, we found a decrease of dosage for the first approximately 25 treatments with an increase afterwards. The number of muscles and inter-injection intervals increased with time with a discrete decrease of inter-injection intervals after about 35 treatments. Subgroup differences were observed in the amount of BoTX and inter-injection intervals, with continuously increasing inter-injection intervals and decreasing BoTX dosage in the low-BTX group. Both groups showed a continuously increasing number of injected muscles. In summary, we found nonlinear changes of BoTX dosage and inter-injection intervals and a continuously increasing number of injected muscles with treatment duration in TSD-patients. Furthermore, we, for the first time, identified two subgroups with distinct differences. Increasing inter-injection intervals and decreasing BoTX dosages in the low-BoTX group indicated improvement of symptoms with continued treatment. Continually increasing BoTX dosages with unchanged inter-injection intervals in the high-BoTX group indicated deterioration.

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Taakspecifieke focale dystonie bij musici

Dooms¹

2021

Tijdschr Geneesk

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Task-specific focal dystonia in musicians Task-specific focal dystonia is a neurological movement disorder characterized by involuntary contractions during a specific activity. In musicians, the abnormal movement can occur while playing an instrument or while singing. The muscle contractions are usually painless, but the function of the affected region is disturbed. The clinical picture occurs more in men than in women and is most frequent in pianists or guitarists. The abnormality is usually localized in the fingers, the hands or the entire arm. Drummers can have problems in the lower limbs. Brass and woodwind players can lose control of the lips, tongue or facial muscles. This is called “embouchure dystonia”. Singers suffer from the larynx. The diagnosis is a clinical diagnosis. It is important to observe the musician making music. Outside the musical activity, all tests are normal. Technical examinations can be useful to rule out other diagnoses. The therapy is difficult and often unsatisfactory. In many cases, the disease predicts the end of the musical career.

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Musikerdystonien

Cited by 3 publications

References 11 publications

BK 2115 – Fokale Dystonie als Erkrankung des zentralen Nervensystems bei Instrumentalmusikern durch feinmotorische Tätigkeit hoher Intensität

BK 2115 – Fokale Dystonie als Erkrankung des zentralen Nervensystems bei Instrumentalmusikern durch feinmotorische Tätigkeit hoher Intensität

Nonlinear Changes in Botulinum Toxin Treatment of Task-Specific Dystonia during Long-Term Treatment

Taakspecifieke focale dystonie bij musici

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