Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors
Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors
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DOI：
10.1111/j.1468-1331.2010.03048.x
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发表时间：
2010-07-01
影响因子：
5.1
通讯作者：
Jabusch, H-C.
中科院分区：
文献类型：
--
作者：
Altenmueller, E.;Jabusch, H-C.
背景：音乐家的肌张力障碍是一种特定任务的运动障碍，表现为在广泛训练的运动中失去自主运动控制。在许多情况下，这种紊乱会终止受影响音乐家的职业生涯。大约有1%的专业音乐家受到影响。这种疾病的病理生理机制尚不清楚。结果包括：(1)中枢神经系统不同层次的抑制降低；(2)适应性不良，如体感皮层和基底神经节；(3)感觉运动加工的改变。方法：查阅文献。结果：流行病学数据显示，弹奏需要最大精细动作技能的乐器的音乐家患肺癌的风险更高。对于不同手的工作量不同的器械，局灶性肌张力障碍更常出现在使用更频繁的那只手上。在心理学研究中，患有肌张力障碍的音乐家比健康的音乐家有更多的完美主义倾向。这些发现加强了行为因素可能参与音乐家肌张力障碍病因的假设。遗传因素的作用可能比以前认为的更大。结论：我们提出了一个启发式模型，可以解释音乐家中相对较高的局灶性肌张力障碍发生率。该模型假设了主要由遗传决定的易感性与内在和外在触发因素之间的相互作用。
Background: Musician's dystonia is a task-specific movement disorder that manifests itself as a loss of voluntary motor control in extensively trained movements. In many cases, the disorder terminates the careers of affected musicians. Approximately, 1% of all professional musicians are affected. The pathophysiology of the disorder is still unclear. Findings include: (i) reduced inhibition in different levels of the central nervous system, (ii) maladaptive plasticity, e. g. in the somatosensory cortex and in the basal ganglia and (iii) alterations in sensorimotor processing.Methods: Review of the literature.Results: Epidemiological data demonstrated a higher risk for those musicians who play instruments requiring maximal fine-motor skills. For instruments where workload differs across hands, focal dystonia appears more often in the more intensely used hand. In psychological studies, musicians with dystonia had more perfectionist tendencies than healthy musicians. These findings strengthen the assumption that behavioural factors may be involved in the etiology of musician's dystonia. Hereditary factors may play a greater role than previously assumed.Conclusions: We propose a heuristic model that may explain the relatively high incidence of focal dystonia in musicians. This model assumes the coactions between a predominantly genetically determined predisposition and intrinsic and extrinsic triggering factors.