Botulinum toxin can help musicians with dystonia

04/20/04

SAN FRANCISCO Injections of the drug botulinum toxin can help musicians with focal task-specific dystonia, a neurological disorder affecting highly accomplished instrumental performers, according to research that will be presented at the American Academy of Neurology 56th Annual Meeting in San Francisco, Calif., April 24 May 1, 2004. Patients with focal dystonia or "occupational cramps" complain about loss of motor control. Involuntary movements and abnormal posture are visible during the performance of highly specific tasks including instrumental playing.

In one study, researchers looked at the long-term result of 84 musicians with focal task-specific dystonia at a German Music Medicine Center in Hanover, who had received botulinum toxin injections and responded to an outcome survey. The musicians described a significant improvement in their playing ability and 69 percent rated the treatment response positive. Thirty-eight musicians (45 percent) indicated that the treatment had a noticeable impact on their performance, either by improving their orchestra position, expanding their repertoire, or increasing their number of public performances. The long-term response showed that 30 out of the 84 musicians (36 percent) either experienced persisting improvement (six musicians) after several injections or continue to benefit from ongoing injections (24 musicians) for an average of three and up to more than six years.

"These results are promising," said study author and neurologist Stephan Schule, MD, of the Cleveland Clinic Foundation in Cleveland, Ohio. "This is a devastating disease for a significant number of musicians, and it often affects highly accomplished performing artists. It leads to the end of the performing career in more than half of them, and we have few treatments that are effective and long-lasting."

The musicians included woodwind players, guitarists, keyboardists, and bowed string instrumentalists. The improvement from the injections was similar between the groups, regardless of the type of instrument played. The musicians had injections, on average, once every four months. The most common injection sites were the forearm flexor muscles.

In a related study by the National Institutes of Health (NIH) that evaluated the effectiveness of botulinum toxin in treating 120 patients with focal hand dystonia (FHD), researchers found that at least minimal benefit was achieved in 61 percent of the 1,100 injection sessions, and that the benefit could be maintained for up to 14 years in some patients.

Neurologist and study co-author Mark Hallett, MD, of the NIH in Bethesda, MD, said, "While botulinum toxin is often an effective treatment for people with FHD, we were able to identify through the study some of the barriers that prevent people from seeking this kind of treatment. They include weakness that outweighs the perceived benefit of the injections, and limited availability of trained local providers."

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