Musician's dystonia in pianists: long-term evaluation of retraining and other therapies.
OBJECTIVE
Musician's dystonia is characterized by loss of voluntary motor control in extensively trained movements on an instrument. The condition is difficult to treat. This retrospective study reports on the interventions received by a homogeneous cohort of pianists with musician's dystonia and the subjective and objective changes reported in task performance.


METHODS
This is a retrospective descriptive study. Fifty four pianists with musician's dystonia who had received care in a Movement Disorders Clinic completed a self report questionnaire regarding type and effectiveness of treatment received over the last 4 years. Pianists' fine motor control was assessed objectively by measuring the temporal regularity of their scale playing.


RESULTS
Nearly all patients (98.0%) reported deficits in motor tasks other than musical playing. Half of the patients were taking medications (Botulinum toxin (53%), Trihexyphenidyl (51%)). Subjects reported participating in multiple therapies: retraining (87%), hand therapy (42%), relaxation techniques (38%), physiotherapy (30%), psychotherapy (23%), acupuncture (21%) and body techniques (21%). Self-reported improvements in motor performance were reported by 81.5% of the subjects with 5.6% reporting a complete recovery. Objective gains in task-specific motor performance were documented in 42.9% of the subjects (with deterioration in 4.8%). Retraining therapy, relaxation techniques and change in teacher explained 52% of the variance in subjective outcomes.


CONCLUSIONS
Musician's dystonia not only interferes with musical performance but other fine motor tasks. Objectively, approximately 50% of patients improved task performance following participation in a variety of intervention strategies, but subjectively, 80% of subjects reported improvement.
Institute of Music Physiology and Musicians' Medicine, University of Music, Drama, and Media, Hannover, Germany; Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, France. Electronic address: f.t.vanvugt@gmail.com.
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van Vugt
Department of Music Physiology, International Piano Academy Lake Como, Italy.
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Boullet
Institute of Musicians' Medicine, Dresden University of Music Carl Maria von Weber, Dresden, Germany.
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Jabusch
Institute of Music Physiology and Musicians' Medicine, University of Music, Drama, and Media, Hannover, Germany. Electronic address: Eckart.Altenmueller@hmtm-hannover.de.
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Altenmüller
D015670:Acupuncture Therapy; D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D020821:Dystonic Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D011613:Psychotherapy; D012189:Retrospective Studies; D014282:Trihexyphenidyl / Q000627:therapeutic use
D000978:Antiparkinson Agents; D009465:Neuromuscular Agents; D014282:Trihexyphenidyl; D019274:Botulinum Toxins, Type A
Dystonia; Motor control; Observational study (cohort, case control); Outcome research; Quality of life