Fokale Dystonie bei Musikern

Hier ein englischer Informationstext zu diesem Forschungsprojekt:

Focal dystonia in musicians is a central focus of our clinical research. Musicians' 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. Until today, the pathophysiology of the disorder is unclear. Neuroimaging studies point at dysfunctional (or maladaptive) neuroplasticity as being involved in the etiology. Support for this theory comes from a functional brain imaging study performed on musicians with focal dystonia. In contrast to healthy musicians, musicians with hand dystonia showed a fusion of the digital representations in the somatosensory cortex, reflected in a decreased distance between the representation of the index finger and the little finger when compared to healthy control musicians (Elbert et al., 1998; Altenmüller, 2003). Since skilled motor actions are necessarily bound to intact sensorimotor feedback loops, it is possible that the loss of motor control in musician’s dystonia might be induced by the aforementioned alterations. At present, however, it cannot be excluded that the observed fusion of the digital representations may alternatively be a consequence of musician’s dystonia.

Epidemiological data have demonstrated a higher risk for those musicians who play instruments requiring a maximum of fine-motor skills. In instruments with different work load for both hands, focal dystonia appears more often in the more heavily used hand. These findings strengthen the assumption that behavioral factors may be involved in the etiology of musician’s dystonia (Jabusch et al., 2005). Recent data suggest that hereditary factors may play a greater role than previously assumed. A pilot study of three families associated with three index patients affected by musician’s dystonia revealed a total of seven relatives affected by other forms of focal task specific dystonia (Schmidt et al., 2006). These preliminary findings suggest a genetic contribution to focal task specific dystonia with phenotypic variations including musician’s dystonia. At present, the outpatient clinic of the Institute offers medical care for more than 400 musicians suffering from focal dystonia. Treatment options include therapy with Botulinumtoxin (Schuele et al., 2005), other pharmaceutical approaches retraining therapies and ergonomic modifications at the instrument (Jabusch et al., 2005). Current research projects aim at improving the therapies and further elucidating the neurobiological causes of this disorder.