Focal dystonia in musicians: From phenomenology to therapy
Focal dystonia in musicians: From phenomenology to therapy
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音乐家的局灶性肌张力障碍：从现象学到治疗
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
E. Altenmüller
中科院分区：
文献类型：
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作者：
H. Jabusch;E. Altenmüller
背景资料：音乐家肌张力障碍是一种特定于任务的运动障碍，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，这种疾病终止了受影响的音乐家的职业生涯。大约1%的专业音乐家受到影响。病因学和病理生理学：该疾病的病理生理学仍不清楚。研究结果包括：（a）中枢神经系统不同水平的抑制减少，（B）适应不良的可塑性，例如躯体感觉皮层和基底神经节，以及（c）感觉运动处理的改变。流行病学数据表明，那些演奏需要最大精细运动技能的乐器的音乐家的风险更高。对于双手工作负荷不同的仪器，局灶性肌张力障碍更常出现在使用更频繁的手中。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学的假设。遗传因素可能比以前假设的起更大的作用。初步研究结果表明，基因的贡献，重点任务特异性肌张力障碍的表型变异，包括音乐家的肌张力障碍。治疗方法：音乐家肌张力障碍的治疗方案包括药物干预，如给予苯海索或肉毒杆菌毒素A，以及再培训计划和仪器的人体工程学变化。对144例音乐家肌张力障碍患者进行了长期随访研究。结果显示，平均8.4年后出现症状。通过患者对累积治疗反应和对个体治疗反应的主观评分来评估结果。77名患者（54%）报告症状缓解：苯海索组33%，肉毒杆菌毒素组49%，教学再培训组50%，无监测技术练习组56%，人体工程学改变组63%。在口部肌张力障碍，只有15%的患者报告改善。结果表明，音乐家的情况与局灶性手肌张力障碍可能会显着改善。经过再培训和未经监测的技术练习后取得的积极成果突出表明，患者积极参与治疗过程是有益的。然而，只有在特殊情况下，患有局灶性肌张力障碍的音乐家才能使用目前可用的治疗方法恢复正常的运动控制。
Background: Musician’s dystonia is a task-specific movement disorder which 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. Etiology and Pathophysiology: The pathophysiology of the disorder is still unclear. Findings include (a) reduced inhibition in different levels of the central nervous system, (b) maladaptive plasticity, e.g. in the somatosensory cortex and in the basal ganglia, and (c) alterations in sensorimotor processing. 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 behavioral factors may be involved in the etiology of musician’s dystonia. Hereditary factors may play a greater role than previously assumed. Preliminary findings suggest a genetic contribution to focal task-specific dystonia with phenotypic variations including musician’s dystonia. Treatment: Treatment options for musician’s dystonia include pharmacological interventions such as administration of Trihexyphenidyl or Botulinum Toxin-A as well as retraining programs and ergonomic changes in the instrument. A long-term follow-up study was performed in 144 patients with musician’s dystonia. The outcome was revealed on average 8.4 years after onset of symptoms. Outcome was assessed by patients’ subjective rating of cumulative treatment response and response to individual therapies. Seventy-seven patients (54%) reported an alleviation of symptoms: 33% of the patients with Trihexyphenidyl, 49% with Botulinum Toxin, 50% with pedagogical retraining, 56% with unmonitored technical exercises, and 63% with ergonomic changes. In embouchure dystonia, only 15% of patients reported improvement. The results demonstrate that the situation of musicians with focal hand dystonia may be significantly improved. Positive results after retraining and unmonitored technical exercises underline the benefit of an active involvement of patients in the treatment process. Only exceptionally, however, can musicians with focal dystonia return to normal motor control using the currently available therapies.