Focal dystonia, also called focal task-specific dystonia, is a neurological condition that affects a muscle or group of muscles in a specific part of the body during specific activities, causing involuntary muscular contractions (spasms) and abnormal postures. There are many different types of focal dystonia, each affecting a different region of the body. For example, in focal hand dystonia, or writer's cramp, the fingers either curl into the palm or extend outward without control. In musicians, the condition is called musician's focal dystonia, or simply, musician's dystonia. In sports, it may be involved in what is commonly referred to as the yips. The condition appears to be associated with over-training, and individualized treatment strategies may involve medications, retraining techniques, and procedures.

Signs and symptoms

People with dystonia experience tightness, cramping, fatigue, involuntary sustained or repetitive muscle contractions that can be painless or painful and resulting in abnormal posturing, twisting motions, and even tremors. Focal dystonia typically presents in adults, more commonly in women ranging from ages 30 through 40. These focal dystonias can be exclusive to specific tasks, like writing or playing an instrument. Focal dystonia will typically have a subtle and slow onset before slowly worsening over years. When the brain tells a given muscle to contract, it simultaneously silences muscles that would oppose the intended movement. It appears that dystonia interferes with the brain's ability to inhibit those surrounding muscles, leading to loss of selectivity. Exploration of this initially involved over-training particular finger movements in non-human primates, which resulted in the development of focal hand dystonia. Examination of the primary somatosensory cortex in the trained animals showed grossly distorted representations of the maps pertaining to the fingers when compared to the untrained animals. Also, synchronous afferent stimulation of peripheral muscles induces organizational changes in motor representations, characterized both by an increase in map size of stimulated muscles and a reduction in map separation, as assessed using transcranial magnetic stimulation.

The cross-connectivity between areas that are normally segregated in the sensory cortex may prevent normal sensorimotor feedback and so contribute to the observed co-contraction of antagonist muscle groups, and inappropriately timed and sequenced movements that underlie the symptoms of focal dystonia. It is hypothesized that a deficit in inhibition caused by a genetically mediated loss of inhibitory interneurons may be the underlying cause of the deficits observed in dystonia. Focal dystonia is generally "task-specific," meaning that it is only problematic during certain activities. The main types of are blepharospasm, oromandibular dystonia, spasmodic dysphonia, spasmodic torticollis, and limb dystonia, all affecting a different region of the body. A provider can rule in or out dopamine-responsive dystonia with a levodopa trial. If possible, incorporating rest earlier to symptom onset has shown to have greater improvement in symptoms for writer's cramp. Bass guitarist and instructor Scott Devine said that he wears a glove while playing bass guitar because of the condition. He finds that the glove stops the involuntary finger movements. He says it works for him but does not suggest that it may work for everyone with the condition.

Medications

Anticholinergics such as Artane can be prescribed for off-label use, as some patients have had success. Benzodiazepines, such as Clonazepam, can be used as a muscle relaxant. For some dystonias, Deep brain stimulation may be considered where BoNT treatment fails.

  • Tom Adams, bluegrass banjo player, has focal dystonia in his right hand, and has switched to the guitar.
  • Badi Assad, Brazilian singer-guitarist, was diagnosed with focal dystonia in 1999; she eventually recovered and resumed her career.
  • Andy Billups, bass guitarist with British rock group, The Hamsters, has made a partial recovery; he plays by using modified guitar plectrums.
  • Liona Boyd, Canadian classical guitarist, publicized as the "First Lady of the Guitar", retired from the concert stage for six years in 2003, due to focal dystonia that affected her right hand. She worked to retrain her right hand, and since 2009 has been performing again as a guitarist, singer, and songwriter.
  • Berkley Breathed, American Pulitzer Prize winning comic strip artist and book writer/illustrator. Known for Bloom County, Opus, and others. His work was featured as that of the main character, as an adult, of the film Second Hand Lions.
  • Stuart Cassells, founder of the bagpipe rock group Red Hot Chilli Pipers, announced focal dystonia in September 2011; he has left the band.
  • Andrew Dawes, noted violinist and co-founder of the Orford String Quartet
  • Scott Devine, bassist and founder of ScottsBassLessons SBL
  • Keith Emerson, pianist and keyboard player
  • Leon Fleisher, an international concert pianist, dealt with this condition in his right hand beginning in the 1960s and switched to only left hand playing. In the 2000s, he regained use of his right hand and recommenced performing and recording with two hands.
  • Dominic Frasca, guitarist
  • Reinhard Goebel, Baroque violinist, switched to playing left-handed.
  • Gary Graffman, pianist, who changed to performing only with his left hand.
  • Jang Jae-in, Korean singer-songwriter and guitarist diagnosed with dystonia in her left hand in 2012. In 2015, on You Hee-yeol's Sketchbook, she announced that she quit playing guitar.
  • Alex Klein, principal oboist of the Chicago Symphony Orchestra
  • Alfred Koffler, guitarist of rock band Pink Cream 69, diagnosed in early 2000s. To help him with live shows, Uwe Reitenauer was hired as a second guitarist. Koffler continues to write and perform live on stage with the band.
  • David Leisner, classical guitarist, has recovered the full use of his hand after a decade of disability.
  • Billy McLaughlin, guitarist, switched to playing left-handed when affected by dystonia.
  • Christian Münzner, lead guitarist of progressive extreme metal band Obscura
  • Apostolos Paraskevas, Greek-American classical guitarist-composer, was struck by focal dystonia to his right hand in 2009. He fully recovered in 2013.
  • Charlie Parr, American country blues musician from Minnesota
  • Satoyasu Shomura, Japanese drummer for rock band Alexandros, suspended live activities in 2019, before full retirement in 2020.
  • Alex Webster, bassist
  • Victor Wooten, bassist, has it on both hands
  • Julian Lage, jazz guitarist
  • Kara Goucher, long distance runner, diagnosed with runner's dystonia in 2021. She had ended her competitive career a few years prior to the diagnosis.
  • Rustem Hayroudinoff, concert pianist
  • Philip Smith, principal trumpet, New York Philharmonic, 1978–2014

References

Sources

  • Tubiana, Raoul, Amadio, Peter C.; Medical Problems of the Instrumentalist Musician; UK; Martin Dunitz (2000); 295-397
  • Farias, Joaquin. "Limitless. How your movements can heal your brain. An essay on the neurodynamics of dystonia". Galene Editions 2016.
  • Farias, Joaquin. "Intertwined. How to induce neuroplasticity. A new approach to rehabilitating dystonias". Galene Editions 2012.
  • Farias, Joaquin. "Rebellion of the body. Understanding musician's Focal dystonia". Galene Editions 2004.
  • Farias, Joaquin - Farias Technique
  • Gorrie, Jon. "Musician's Focal Dystonia"