title: The brighter side of music in dystonia.
abstract: OBJECTIVE
  To report a patient with genetically proven DYT1 dystonia who shows dramatic improvement in symptoms while playing the piano.
  
  
  METHODS
  Case study.
  
  
  METHODS
  Sobell Department for Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, England.
  
  
  METHODS
  A 49-year-old right-handed male civil servant.
  
  
  METHODS
  The patient was videotaped, and electromyographic activity was recorded from the splenius capitis, sternocleidomastoid, and orbicularis oculi muscles, while he was (1) at rest, (2) playing an electric piano with auditory feedback, and (3) playing an electric piano without auditory feedback (ie, when the sound of the piano is turned off).
  
  
  RESULTS
  At baseline, the patient had generalized dystonia with prominent upper limb, neck, and facial involvement. While he was playing the piano, there was an instant and almost complete improvement in dystonia symptoms. The improvement was also noticeable when he played the piano without auditory feedback. There was a significant reduction in electromyographic activity for all recorded muscles when he played the piano, compared with his baseline electromyographic activity.
  
  
  CONCLUSIONS
  This is a unique case of “paradoxical” improvement in dystonia symptoms with activity (ie, playing a piano), in contrast to the typical worsening of dystonia symptoms with activity. We discuss the possible mechanisms underlying this phenomenon. One of the most intriguing features of primary dystonia is the variability of abnormal muscle activity relative to the context in which movement is attempted (eg, the exquisite task specificity of focal hand dystonia or the phenomenon of the geste antagoniste). We present a unique case of an amateur pianist with genetically proven DYT1 dystonia who shows dramatic improvement in generalized dystonia symptoms while playing piano.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, England, UK. maja.kojovic.09@ucl.ac.uk
authors.forename: Maja
authors.initials: M
authors.lastname: Kojovic
authors.forename: Isabel
authors.initials: I
authors.lastname: Pareés
authors.forename: Anna
authors.initials: A
authors.lastname: Sadnicka
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kassavetis
authors.forename: Ignacio
authors.initials: I
authors.lastname: Rubio-Agusti
authors.forename: Tabish A
authors.initials: TA
authors.lastname: Saifee
authors.forename: Matteo
authors.initials: M
authors.lastname: Bologna
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Kailash P
authors.initials: KP
authors.lastname: Bhatia
mesh_terms: D004421:Dystonia / Q000235:genetics / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018832:Molecular Chaperones / Q000235:genetics; D009147:Music Therapy / Q000379:methods*; D011597:Psychomotor Performance
chemical_list: D018832:Molecular Chaperones; C108175:TOR1A protein, human