Sensorimotor reorganization by proprioceptive training in musician's dystonia and writer's cramp

Rosenkranz, Karin; Butler, Katherine; Williamon, Aaron; Cordivari, Carla; Lees, Andrew; Rothwell, John C.

doi:10.1212/01.wnl.0000296829.66406.14

Cited by 79 publications

(53 citation statements)

References 37 publications

(65 reference statements)

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“…Recent studies comparing MD and WC patients using transcranial magnetic stimulation suggested pathophysiologic differences between the two conditions. 16,17 Given a possible common genetic cause of MD and WC in at least a subset of patients as confirmed by the present study, however, these neurophysiologic differences could be interpreted as a secondary rather than a primary phenomenon.…”

Section: Patients and Familiessupporting

confidence: 59%

Etiology of musician’s dystonia

Schmidt¹,

Jabusch²,

Altenmüller³

et al. 2009

Neurology

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Objective: To test the hypothesis that there is familial aggregation of dystonia and other movement disorders in relatives of patients with musician's dystonia (MD) and to identify possible environmental triggers. Methods:The families of 28 index patients with MD (14 with a reported positive family history of focal task-specific dystonia [FTSD] and 14 with no known family history [FHϪ]) underwent a standardized telephone screening interview using a modified version of the Beth Israel Dystonia Screen. Videotaped neurologic examinations were performed on all participants who screened positive and consensus diagnoses established. All patients were investigated for DYT1 dystonia and suitable families were tested for linkage to DYT7. All family members were administered questionnaires covering potential triggers of FTSD.Results: A diagnosis of dystonia was established in all 28 index patients and in 19/97 examined relatives (MD: n ϭ 8, other FTSD: n ϭ 9, other dystonias: n ϭ 2), 5 of whom were members of FHϪ families. In 27 of the 47 affected individuals, additional forms of dystonia were seen; other movement disorders were observed in 23 patients. In total, 18 families were multiplex families with two to four affected members. Autosomal dominant inheritance was compatible in at least 12 families. The GAG deletion in DYT1 was absent in all patients. Linkage to DYT7 could be excluded in 1 of the 11 informative families. With respect to potential environmental triggers, there was no significant difference between patients with MD/FTSD compared to unaffected family members. Conclusion:Our results suggest a genetic contribution to musician's dystonia with phenotypic variability including focal task-specific dystonia. Neurology ® 2009;72:1248-1254 GLOSSARY BIDS ϭ Beth Israel Dystonia Screen; FH؉ ϭ reported positive family history of focal task-specific dystonia; FH؊ ϭ no known family history of focal task-specific dystonia; FTSD ϭ focal task-specific dystonia; MD ϭ musician's dystonia; WC ϭ writer's cramp.Musician's dystonia (MD), a type of focal task-specific dystonia (FTSD), presents with painless muscular incoordination or loss of voluntary motor control of extensively trained movements when a musician is playing his or her instrument. It is usually confined to a limb or embouchure.1-4 The frequency of MD is estimated at about 1% among professional musicians; it is highly disabling and in many cases terminates performance careers. 1While the pathophysiology remains largely elusive, MD has been associated with intensive training regimes and thus been considered a form of occupational cramp. However, the epidemiology also suggests a possible hereditary component: 10% of patients with MD report a positive family history of dystonia.1 Clinical examination of relatives of patients with other forms of focal dystonia revealed even

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Section: Patients and Familiessupporting

confidence: 59%

Etiology of musician’s dystonia

Schmidt¹,

Jabusch²,

Altenmüller³

et al. 2009

Neurology

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“…However, we wish to highlight the involvement of trigger factors linked to the specific requirements of playing music and fine motor control (playing speed, trills, vibrato, etc.). This is consistent with sensorimotor integration and inhibitory control alterations described in this disorder, 29,30 and it may be especially relevant for selecting repertoire to be played during the musician's rehabilitation. When patients are students, this may require cooperation from their teachers.…”

Section: Discussionsupporting

confidence: 85%

Focal dystonia in musicians: Phenomenology and musical triggering factors

Aránguiz

Chaná-Cuevas

Alburquerque

et al. 2015

Neurología (English Edition)

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Dystonias are defined as a joint sustained and involuntary contraction of agonist and antagonist muscles, which can cause torsion, repetitive abnormal involuntary movements, and/or abnormal postures. One special group of dystonias are those known as occupational, which include dystonia disorders triggered by a repetitive motor activity associated with a specific professional activity or task. Musicians are a population particularly vulnerable to these types of dystonia, which are presented as a loss of coordination and voluntary motor control movements highly trained in musical interpretation. Our aim is to describe a clinical series of focal dystonias in musicians evaluated and treated in our centre.Patients and methods: Data are presented on a clinical series of 12 musicians with occupational dystonia. Their history and phenomenology are described, as well as well as their outcome after therapy.Results: Demographic details: Mean age 34.8 ± 11.8 years, 10 males (83.3%) and 2 females (16.7%). Clinical history: History of trauma in dystonic segment, 6 patients (50%); family history of neurological diseases in first-degree relatives, 6 patients (50%). Occupational history according to music category: 8 patients (66.6%) were classical musicians and 4 patients (33.3%) were popular musicians.Phenomenology: Dystonia syndrome was characterised by having a mean age of onset of 28.2 ± 11.3 years (range 18-57 years). The segment affected was the hand (91.7%) in 11 patients. Of all the musicians seen in the clinic, 9 of them (75%) received therapy. The majority of patients appeared to have triggering factors specific to musical execution and linked to the requirement of fine motor control. It should be mentioned that 50% of the musicians treated maintained their professional activity or position in the orchestra to which they belonged.ଝ Please cite this article as: Aránguiz R, Chana-Cuevas P, Alburquerque D, Curinao X. Distonía del músico: fenomenología y desencadenantes vinculados a la ejecución musical. Neurología. 2015;30:270-275. Focal dystonia in musicians 271 Conclusions: The majority of our phenomenological findings are consistent with those reported in the current literature. However, it is worth mentioning the presence of triggering factors attributed to the specific requirements of performing music, linked to the participation of fine motor control. Distonía del músico: fenomenología y desencadenantes vinculados a la ejecución musicalResumen Las distonías se definen como una contracción conjunta, sostenida e involuntaria de músculos agonistas y antagonistas, que puede causar torsión, movimientos involuntarios anormales repetitivos y/o posturas anormales. Un grupo especial de distonías son las conocidas como ocupacionales, que incluyen trastornos distónicos desencadenados por una actividad motora repetitiva, relacionada con la actividad profesional o tarea específica. Los músicos son una población especialmente vulnerable a este tipo de distonías que se presentan como una pérdida de coordinación y control motor ...

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“…The alpha-band power and coherence S1-M1 coherence increases could be the effect of both abnormal primary sensorimotor representations as well as a strategy to compensate for the loss of physiological inhibition. A better understanding of those mechanisms could give the chance for the development of neurophysiology-driven therapeutic approaches (Zeuner et al, 2002;Rosenkranz et al, 2008;Tinazzi et al, 2009b). In fact, pathogenesis-targeted treatment is still elusive in dystonias and rehabilitative techniques based on sensory-motor recalibration (sensorimotor retuning, sensory/proprioceptive retraining, limb immobilization, selective peripheral denervation, well-fitted braces and proprioceptive training) have failed to demonstrate sustained, long-term benefits (for a review, see Jankovic, 2006).…”

Section: Discussionmentioning

confidence: 99%