Retraining and transcranial direct current stimulation in Musician's Dystonia — A case report

Buttkus, Franziska; Baur, Volker; Jabusch, Hans‐Christian; Paulus, Walter; Nitsche, Michael A.; Altenmüller, Eckart

doi:10.1002/mds.23259

Cited by 14 publications

(14 citation statements)

References 6 publications

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“…Understanding metaplasticity of musicians is important for unraveling pathophysiological mechanism of focal dystonia, a neurological disorder eliciting maladaptive neuroplastic changes that degrade the motor system involved in fine motor control. In keeping with this, a case report showed an improvement of fine motor control in a pianist suffering from focal dystonia with tDCS over days [18], which was interpreted as an induction of beneficial brain plasticity using tDCS. It is therefore likely to predict that plastic changes induced by stimulating the motor system of musicians might be possibly even large for musicians who commenced musical training early.…”

Section: Introductionmentioning

confidence: 76%

Early optimization in finger dexterity of skilled pianists: implication of transcranial stimulation

et al. 2013

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BackgroundIt has been shown that non-invasive transcranial direct current stimulation (tDCS) facilitates motor functions in healthy adults and stroke patients. However, little is known about neuroplastic changes induced by tDCS in highly-trained individuals. Here we addressed this issue by assessing the effect of tDCS on dexterity of finger movements in healthy adult pianists. Twelve pianists practiced bimanual keystrokes in an in-phase manner while bilateral tDCS (left anodal/right cathodal or vice versa) of the primary motor cortex was performed. Before and after stimulation, each participant was asked to perform the trained successive keystrokes, and to repetitively strike a key with each of the fingers as fast and accurate as possible while keeping the remaining fingers immobilized voluntarily.ResultsIn contrast to previous findings in untrained individuals, tDCS yielded overall no apparent improvement of fine control of finger movements in the professional pianists. However, for some movement features, pianists who commenced training at later age demonstrated larger improvements of fine motor control following tDCS.ConclusionsThese findings, in combination with lack of any correlation between the age at which pianists commenced the training and motor improvements for sham stimulation conditions, supports the idea that selectively late-started players benefit from tDCS, which we interpret as early optimization of neuroplasticity of the motor system.

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Section: Introductionmentioning

confidence: 76%

Early optimization in finger dexterity of skilled pianists: implication of transcranial stimulation

et al. 2013

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“…However, there was a large variability between studies in terms of stimulation parameters, type of motor training tested, and duration of intervention. Overall, significant improvements in musical performance, sensory discrimination, dystonia severity, and emotional well‐being were observed after motor training combined with neuromodulation in focal hand dystonia . In musician's dystonia, better outcomes were reported for cathodal stimulation in comparison to other conditions, and for real stimulation versus sham .…”

Section: Resultsmentioning

confidence: 93%

“…Studies in this category tested some modality of motor training paired with neuromodulation methods ( n = 5), such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), or intermittent theta burst stimulation (iTBS) . Stimulation sites tested included the premotor cortex, primary motor cortex, and the cerebellum …”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Rehabilitation in Focal Dystonias: Classification and Recommendations

Prudente

Zetterberg

Bring

et al. 2018

Movement Disord Clin Pract

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BackgroundRehabilitation interventions are rarely utilized as an alternative or adjunct therapy for focal dystonias. Reasons for limited utilization are unknown, but lack of conclusive evidence of effectiveness is likely a crucial factor.Methods and FindingsThe purpose of this systematic review was to determine the level of evidence for rehabilitation interventions in focal dystonias. Rehabilitation interventions were classified based upon the underlying theoretical basis of different approaches, and the strength of evidence for each category was evaluated to identify gaps in the field. Prospective studies using rehabilitation methods in cervical, hand, and foot dystonia were reviewed. The key elements of treatments tested were identified and studies were grouped into six categories based on the theoretical basis of the intervention: (1) movement practice, (2) training with constraint, (3) sensory reorganization, (4) normalization of muscle activity with external techniques, (5) neuromodulation with training, and (6) compensatory strategies. Quality of the body of evidence ranged from very low‐to‐low according to the grades of recommendation, assessment, development, and evaluation (GRADE). Despite inconclusive evidence for these rehabilitation approaches, data suggest that intensive movement practice and neuromodulation combined with motor training should be further explored.ConclusionsThis systematic review presents a novel approach to classify studies of rehabilitation in focal dystonias based on the theoretical basis of intervention. The proposed classification system will move toward a unified theoretical understanding of rehabilitation interventions in dystonia. Moreover, it will help provide recommendations for clinical applications and future investigations.

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“…In patients with musician’s dystonia (e.g., professional guitarists), a single session of cathodal tDCS targeting the affected M1 did not improve the performance of guitar playing (172). Similarly in pianists, a single session of cathodal or anodal tDCS of the affected M1 combined with simultaneous retraining consisting of slow, voluntarily controlled movements on the piano did not result in any improvement in dystonia (173). The same strategy did not help patients with writer’s cramp (174).…”

Section: Therapymentioning

confidence: 97%

“…Similar to constraint-movement therapy, a method often used in stroke rehabilitation, some investigators have used motor practice combined with constraining the unaffected joints with the goal of decreasing compensatory movements (152, 153). Finally, combining neuromodulation methods with motor training in an attempt to normalize brain excitability and further improve motor performance has been tried either with transcranial direct current stimulation (tDCS) (154–156) or with rTMS (140). …”

Section: Therapymentioning

confidence: 99%

Research Priorities in Limb and Task-Specific Dystonias

et al. 2017

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Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.

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Retraining and transcranial direct current stimulation in Musician's Dystonia — A case report

Cited by 14 publications

References 6 publications

Early optimization in finger dexterity of skilled pianists: implication of transcranial stimulation

Early optimization in finger dexterity of skilled pianists: implication of transcranial stimulation

Systematic Review of Rehabilitation in Focal Dystonias: Classification and Recommendations

Research Priorities in Limb and Task-Specific Dystonias

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