Motor and Sensory Dysfunction in Musician's Dystonia

Florence C F Chang, Steven J Frucht, Florence C F Chang, Steven J Frucht

Abstract

Musicians' dystonia is a task-specific and painless loss of motor control in a previously well-executed task. It is increasingly recognized in the medical and musical community. Recent advances in neuroimaging, transcranial magnetic stimulation and novel techniques in electroencephalography have shed light on its underlying pathophysiology. To date, a deranged cortical plasticity leading to abnormal sensorimotor integration, combined with reduced inhibition across several levels of the motor pathway are likely mechanisms.This paper reviews the various phenomenology of musician's dystonia across keyboard, string, brass, flute and drum players. Treatment is often challenging. Medical therapies like botulinum toxin injection and rehabilitation method with sensorimotor training offer symptomatic relief and return to baseline performance to some musicians.

Keywords: Botulinum toxin; cortical plasticity; dystonia; musician; rehabilitation; trihexyphenidyl..

References

    1. Altenmuller E. Causes and cures of focal limb-dystonia in musicians. Intl. Soc. Tension Performance. 1998;(9):13–17.
    1. Brandfonbrener A. Musicians with focal dystonia: a report of 58 cases seen during a ten-year period at a performing arts medicine clinic. Med. Probl. Performing Art. 1995;10:121–127.
    1. Altenmuller E. Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians. Hand Clin. 2003;19(3):523–38. xi.
    1. Byl N N, Merzenich M M, Jenkins W M. A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys. Neurology. 1996;47(2):508–20.
    1. Conti A M, Pullman S, Frucht S J. The hand that has forgotten its cunning--lessons from musicians' hand dystonia. Mov. Disord. 2008;23(10):1398–406.
    1. Jankovic J, Ashoori A. Movement disorders in musicians. Mov. Disord. 2008;23(14):1957–65.
    1. Frucht S J. Focal task-specific dystonia of the musicians' hand--a practical approach for the clinician. J. Hand Ther. 2009;22(2):136–42. quiz 143.
    1. Altenmuller E, Jabusch H C. Focal hand dystonia in musicians: phenomenology, etiology, and psychological trigger factors. J. Hand Ther. 2009;22(2):144–54. quiz 155.
    1. Altenmuller E, Jabusch H C. Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors. Eur. J. Neurol. 2010;17(Suppl 1):31–6.
    1. Kadota H, Nakajima Y, Miyazaki M, Sekiguchi H, Kohno Y, Amako M, Arino H, Nemoto K, Sakai N. An fMRI study of musicians with focal dystonia during tapping tasks. J. Neurol. 2010;257(7):1092–8.
    2. Haslinger B, Altenmuller E, Castrop F, Zimmer C, Dresel C. Sensorimotor overactivity as a pathophysiologic trait of embouchure dystonia. Neurology. 2010;74(22):1790–7.
    1. Granert O, Peller M, Jabusch H C, Altenmuller E, Siebner H R. Sensorimotor skills and focal dystonia are linked to putaminal grey-matter volume in pianists. J. Neurol. Neurosurg. Psychiatry. 2011;82(11):1225–31.
    1. Ruiz M H, Strubing F, Jabusch H C, Altenmuller E. EEG oscillatory patterns are associated with error prediction during music performance and are altered in musician's dystonia. Neuroimage. 2011;55(4):1791–803.
    1. Enders L, Spector J T, Altenmuller E, Schmidt A, Klein C, Jabusch H C. Musician's dystonia and comorbid anxiety: two sides of one coin? Mov. Disord. 2011;26(3):539–42.
    1. Schmidt A J H, Altenmuller E, Enders L, Saunders-Pullman R, Bressman S B, Munchau A, Hagenah J, Klein C. Phenotypic spectrum of musicians' dystonia: A task-specific disorder? Mov. Disorder. 2011;26(S2):S228–229.
    1. Schmidt A, Altenmüller E, Jabusch HC, Winkler S, Lohnau T, Wiegers K, Lohmann K, Klein C. 5th International Dystonia Symposium. Barcelona, Spain: 2011. Screening for mutations in dystonia genes Tor1A (DYT1) and THAP1 (DYT6) in musicians with focal dystonia; p. P074.
    1. Berque P, Gray H, Harkness C, McFadyen A. A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med. Probl. Perform Art. 2010;25(4):149–61.
    1. Rosset-Llobet J, Fabregas-Molas S. Long-term treatment effects of sensory motor retuning in a pianist with focal dystonia. Med. Probl. Perform Art. 2011;26(2):106–7.
    1. Buttkus F, Weidenmuller M, Schneider S, Jabusch H C, Nitsche M A, Paulus W, Altenmuller E. Failure of cathodal direct current stimulation to improve fine motor control in musician's dystonia. Mov. Disord. 2010;25(3):389–94.
    1. Lim V K A E. Musicians' cramp: instrumental and gender differences. Med. Probl. Performing Arts. 2003;18:21–6.
    1. Wilson F. The hand: how its use shapes the brain, language and human culture. New York: Vintage Books; 1998.
    1. Lim V K, Bradshaw J L, Nicholls M E, Altenmuller E. Perceptual differences in sequential stimuli across patients with musician's and writer's cramp. Mov. Disord. 2003;18(11):1286–93.
    1. Jabusch H C A E. Focal dystonia in musicians: from phenomenology to therapy. Adv. Cogn. Psychol. 2006;2(2-3):207–220.
    1. Charness M E, Ross M H, Shefner J M. Ulnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians. Muscle Nerve. 1996;19(4):431–7.
    1. Schmidt A, Jabusch H C, Altenmuller E, Hagenah J, Bruggemann N, Hedrich K, Saunders-Pullman R, Bressman S B, Kramer P L, Klein C. Dominantly transmitted focal dystonia in families of patients with musician's cramp. Neurology. 2006;67(4):691–3.
    2. Defazio G B A, Mark Hallett. Do Primary adult-onset focal dystonias share aetiological factors? Brain. 2007;130:1183–1193.
    1. Sommer M, Ruge D, Tergau F, Beuche W, Altenmuller E, Paulus W. Intracortical excitability in the hand motor representation in hand dystonia and blepharospasm. Mov. Disord. 2002;17(5):1017–25.
    1. Rosenkranz K, Williamon A, Rothwell J C. Motorcortical excitability and synaptic plasticity is enhanced in professional musicians. J. Neurosci. 2007;27(19):5200–6.
    1. Hund-Georgiadis M, von Cramon D Y. Motor-learning-related changes in piano players and non-musicians revealed by functional magnetic-resonance signals. Exp. Brain Res. 1999;125(4):417–25.
    1. Ridding M C, Brouwer B, Nordstrom M A. Reduced interhemispheric inhibition in musicians. Exp. Brain Res. 2000;133(2):249–53.
    1. Classen J, Liepert J, Wise S P, Hallett M, Cohen L G. Rapid plasticity of human cortical movement representation induced by practice. J. Neurophysiol. 1998;79(2):1117–23.
    1. Karni A, Meyer G, Jezzard P, Adams M M, Turner R, Ungerleider L G. Functional MRI evidence for adult motor cortex plasticity during motor skill learning. Nature. 1995;377(6545):155–8.
    1. Elbert T, Pantev C, Wienbruch C, Rockstroh B, Taub E. Increased cortical representation of the fingers of the left hand in string players. Science. 1995;270(5234):305–7.
    1. Schlaug G. The brain of musicians. A model for functional and structural adaptation. Ann. N. Y. Acad. Sci. 2001;930:281–99.
    1. Amunts K, Schlaug G, Jancke L, Steinmetz H, Schleicher A, Dabringhaus A, Zilles K. Motor cortex and hand motor skills: structural compliance in the human brain. Hum. Brain Mapp. 1997;5(3):206–15.
    2. Schlaug G, Jancke L, Huang Y, Staiger J F, Steinmetz H. Increased corpus callosum size in musicians. Neuropsychologia. 1995;33(8):1047–55.
    1. Levy L M, Hallett M. Impaired brain GABA in focal dystonia. Ann. Neurol. 2002;51(1):93–101.
    1. Murase N, Kaji R, Shimazu H, Katayama-Hirota M, Ikeda A, Kohara N, Kimura J, Shibasaki H, Rothwell J C. Abnormal premovement gating of somatosensory input in writer's cramp. Brain J. Neurol. 2000;123( Pt 9):1813–29.
    1. Quartarone A, Bagnato S, Rizzo V, Siebner H R, Dattola V, Scalfari A, Morgante F, Battaglia F, Romano M, Girlanda P. Abnormal associative plasticity of the human motor cortex in writer's cramp. Brain J. Neurol. 2003;126(Pt 12):2586–96.
    1. Peller M, Zeuner K E, Munchau A, Quartarone A, Weiss M, Knutzen A, Hallett M, Deuschl G, Siebner H R. The basal ganglia are hyperactive during the discrimination of tactile stimuli in writer's cramp. Brain J. Neurol. 2006;129(Pt 10):2697–708.
    1. Panizza M E, Hallett M, Nilsson J. Reciprocal inhibition in patients with hand cramps. Neurology. 1989;39(1):85–9.
    2. Nakashima K, Rothwell J C, Day B L, Thompson P D, Shannon K, Marsden C D. Reciprocal inhibition between forearm muscles in patients with writer's cramp and other occupational cramps, symptomatic hemidystonia and hemiparesis due to stroke. Brain. 1989;112(Pt 3):681–97.
    1. Cohen L G, Hallett M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. 1988;38(7):1005–12.
    1. Brighina F, Romano M, Giglia G, Saia V, Puma A, Giglia F, Fierro B. Effects of cerebellar TMS on motor cortex of patients with focal dystonia: a preliminary report. Exp. Brain Res. 2009;192(4):651–6.
    1. Tamura Y, Ueki Y, Lin P, Vorbach S, Mima T, Kakigi R, Hallett M. Disordered plasticity in the primary somatosensory cortex in focal hand dystonia. Brain. 2009;132(Pt 3):749–55.
    1. Lim V K, Bradshaw J L, Nicholls M E, Altenmuller E. Enhanced P1-N1 auditory evoked potential in patients with musicians' cramp. Ann. N. Y. Acad. Sci. 2005;1060:349–59.
    1. Yoneda Y, Rome S, Sagar H J, Grunewald R A. Abnormal perception of the tonic vibration reflex in idiopathic focal dystonia. Eur. J. Neurol. 2000;7(5):529–33.
    1. Tempel L W, Perlmutter J S. Abnormal cortical responses in patients with writer's cramp. Neurology. 1993;43(11):2252–7.
    1. Rosenkranz K, Williamon A, Butler K, Cordivari C, Lees A J, Rothwell J C. Pathophysiological differences between musician's dystonia and writer's cramp. Brain. 2005;128(Pt 4):918–31.
    1. Bradley D, Whelan R, Kimmich O, O'Riordan S, Mulrooney N, Brady P, Walsh R, Reilly R B, Hutchinson S, Molloy F, Hutchinson M. Temporal discrimination thresholds in adult-onset primary torsion dystonia: an analysis by task type and by dystonia phenotype. J. Neurol. 2012;259(1):77–82.
    1. Bara-Jimenez W, Shelton P, Hallett M. Spatial discrimination is abnormal in focal hand dystonia. Neurology. 2000;55(12):1869–73.
    1. Bara-Jimenez W, Shelton P, Sanger T D, Hallett M. Sensory discrimination capabilities in patients with focal hand dystonia. Ann. Neurol. 2000;47(3):377–80.
    1. Hallett M. The neurophysiology of dystonia. Arch. Neurol. 1998;55(5):601–3.
    1. Elbert T, Candia V, Altenmuller E, Rau H, Sterr A, Rockstroh B, Pantev C, Taub E. Alteration of digital representations in somatosensory cortex in focal hand dystonia. Neuroreport. 1998;9(16):3571–5.
    1. Hirata Y, Schulz M, Altenmuller E, Elbert T, Pantev C. Sensory mapping of lip representation in brass musicians with embouchure dystonia. Neuroreport. 2004;15(5):815–8.
    1. Pascual-Leone A. The brain that plays music is changed by it. Ann. N. Y.Acad. Sci. 2001:315–329.
    1. Meunier S, Garnero L, Ducorps A, Mazieres L, Lehericy S, du Montcel S T, Renault B, Vidailhet M. Human brain mapping in dystonia reveals both endophenotypic traits and adaptive reorganization. Ann. Neurol. 2001;50(4):521–7.
    1. Delmaire C, Krainik A, Tezenas du Montcel S, Gerardin E, Meunier S, Mangin J F, Sangla S, Garnero L, Vidailhet M, Lehericy S. Disorganized somatotopy in the putamen of patients with focal hand dystonia. Neurology. 2005;64(8):1391–6.
    1. Wang X, Merzenich M M, Sameshima K, Jenkins W M. Remodelling of hand representation in adult cortex determined by timing of tactile stimulation. Nature. 1995;378(6552):71–5.
    1. Jancke L, Shah N J, Peters M. Cortical activations in primary and secondary motor areas for complex bimanual movements in professional pianists. Brain Research. Cognitive Brain Res. 2000;10(1-2):177–83.
    2. Krings T, Topper R, Foltys H, Erberich S, Sparing R, Willmes K, Thron A. Cortical activation patterns during complex motor tasks in piano players and control subjects. A functional magnetic resonance imaging study. Neurosci. Lett. 2000;278(3):189–93.
    1. Herrojo Ruiz M, Senghaas P, Grossbach M, Jabusch H-C, Bangert M, Hummel F, Gerloff C, Altenmüller E. Defective inhibition and inter-regional phase synchronization in pianists with musician's dystonia: An EEG study. Hum. Brain Mapping. 2009;30(8):2689–2700.
    1. Deuschl G, Toro C, Matsumoto J, Hallett M. Movement-related cortical potentials in writer's cramp. Ann. Neurol. 1995;38(6):862–8.
    1. Pujol J, Roset-Llobet J, Rosines-Cubells D, Deus J, Narberhaus B, Valls-Sole J, Capdevila A, Pascual-Leone A. Brain cortical activation during guitar-induced hand dystonia studied by functional MRI. Neuroimage. 2000;12(3):257–67.
    1. Rosenkranz K, Butler K, Williamon A, Rothwell J C. Regaining motor control in musician's dystonia by restoring sensorimotor organization. J. Neurosci. 2009;29(46):14627–36.
    1. Rosenkranz K, Altenmuller E, Siggelkow S, Dengler R. Alteration of sensorimotor integration in musician's cramp: impaired focusing of proprioception. Clin. Neurophysiol. 2000;111(11):2040–5.
    1. Kim J S, An J Y, Lee K S, Kim H T. Cooling can relieve the difficulty of playing the tuba in a patient with embouchure dystonia. Mov. Disord. 2007;22(15):2291–2.
    1. Baur V, Jabusch H C, Altenmuller E. Behavioral factors influence the phenotype of musician's dystonia. Mov. Disord. 2011;26(9):1780–1.
    1. Rosset-Llobet J, Candia V, Fabregas S, Ray W, Pascual-Leone A. Secondary motor disturbances in 101 patients with musician's dystonia. J. Neurol. Neurosurg. Psychiatry. 2007;78(9):949–53.
    1. Marsden C D, Sheehy M P. Writer's cramp. Trends Neurosci. 1990;13(4):148–53.
    1. Schuele S, Lederman R J. Long-term outcome of focal dystonia in string instrumentalists. Mov. Disord. 2004;19(1):43–8.
    1. Frucht S J. Embouchure dystonia--Portrait of a task-specific cranial dystonia. Mov. Disord. 2009;24(12):1752–62.
    1. Frucht S J, Fahn S, Greene P E, O'Brien C, Gelb M, Truong D D, Welsh J, Factor S, Ford B. The natural history of embouchure dystonia. Mov. Disord. 2001;16(5):899–906.
    1. Lederman R J. Drummer's dystonia. Med. Prob. Performing Artists. 2004;19(2):70.
    1. Ragothaman M, Sarangmath N, Jayaram S, Swaminath P V, Muthane U. Task-specific dystonia in tabla players. Mov. Disord. 2004;19(10):1254–6.
    1. Chitkara A, Meyer T, Keidar A, Blitzer A. Singer's dystonia: first report of a variant of spasmodic dysphonia. Ann. Otol. Rhinol. Laryngol. 2006;115(2):89–92.
    1. Jabusch H C, Zschucke D, Schmidt A, Schuele S, Altenmuller E. Focal dystonia in musicians: treatment strategies and long-term outcome in 144 patients. Mov. Disord. 2005;20(12):1623–6.
    1. Schuele S, Jabusch H C, Lederman R J, Altenmuller E. Botulinum toxin injections in the treatment of musician's dystonia. Neurology. 2005;64(2):341–3.
    1. Candia V, Wienbruch C, Elbert T, Rockstroh B, Ray W. Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization. Proc. Natl. Acad. Sci. U. S. A. 2003;100(13):7942–6.
    1. Byl N N, McKenzie A. Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study. J. Hand Ther. 2000;13(4):289–301.
    1. Tubiana R C P. Prolonged rehabilitation treatment of musicians' focal dystonia. In: Tubiana R A P, editor. Medical Problems of the Instrumentalist Musician. London: Martin Dunitz Ltd; 2000. pp. 244–269.

Source: PubMed

3
Prenumerera