Objective: To assess differences in playing ability and outcome of patients with Musician’s Hand (FHD) and Embouchure Dystonia (ED).

Background: Musician’s Dystonia (MD) is a task specific dystonia that impairs fine motor control of musicians at the instrument. Two sub entities exist: FHD and ED. While it is possible to identify muscles involved in FHD, allowing for targeted therapy with botulinum toxin, this is much more challenging in ED, as multiple muscle groups can be involved (muscles of the lips, tongue or larynx). Also, trihexyphenidyl, another common treatment for MD, was shown to be less effective in ED. Thus we hypothesized that the course of dystonia differs between FD and ED.

Method: We included 265 patients with FHD and 92 patients with ED, treated in an outpatient clinic for Musician’s Medicine. Participants filled in a questionnaire which assessed their playing ability (in % of their playing ability before MD) after onset of MD and at the time of filling in the questionnaire. We assessed epidemiological data and treatment. We used an ANOVA for comparison of playing ability, Wilcoxon tests for non-parametrical and χ2-tests for categorical data.

Results: Playing ability at onset of dystonia was significantly worse in patients with ED than in patients with FHD and only FHD patients but not ED patients significantly improved over the course of the disease. ED-patients used significantly less treatment options. There was no significant difference between groups in gender distribution, age at / cumulative practice time until onset of dystonia or time between onset of dystonia and time at filling in the questionnaire.

Conclusion: We found that in ED playing ability is worse at onset of MD and that an improvement occurs only in FHD. Furthermore, ED patients receive less treatment than MD patients. This has implications for counselling and the need to address an alternative to professional musicianship already at the time of diagnosis in ED patients. It reflects the limited therapeutic options and the need for new treatment options. However, we consider it unlikely that the worse outcome in ED can be explained only by limited treatment options. The reasons are speculative and likely multifactorial. They may include fewer possibilities for compensating for the symptoms in ED but might also imply possible underlying differences in pathophysiology in the two entities of MD. Further research is needed to elucidate these questions.

References: Altenmüller, E., Ioannou, C. I., & Lee, A. (2015). Apollo’s curse: Neurological causes of motor impairments in musicians. Progress in Brain Research, 217, 89–106. https://doi.org/10.1016/bs.pbr.2014.11.022
Altenmüller, & Jabusch. (2010). Focal dystonia in musicians: Phenomenology, pathophysiology and triggering factors. European Journal of Neurology, 17(s1), 31–36. https://doi.org/10.1111/j.1468-1331.2010.03048.x
Frucht, S. J. (2009). Embouchure dystonia—Portrait of a task-specific cranial dystonia. Movement Disorders: Official Journal of the Movement Disorder Society, 24(12), 1752–1762. https://doi.org/10.1002/mds.22550
Frucht, S. J., Fahn, S., Greene, P. E., O’Brien, C., Gelb, M., Truong, D. D., Welsh, J., Factor, S., & Ford, B. (2001). The natural history of embouchure dystonia. Movement Disorders: Official Journal of the Movement Disorder Society, 16(5), 899–906.
Jabusch, H.-C., Zschucke, D., Schmidt, A., Schuele, S., & Altenmüller, E. (2005). Focal dystonia in musicians: Treatment strategies and long-term outcome in 144 patients. Movement Disorders: Official Journal of the Movement Disorder Society, 20(12), 1623–1626. https://doi.org/10.1002/mds.20631
Schmidt, A., Jabusch, H.-C., Altenmüller, E., Kasten, M., & Klein, C. (2013). Challenges of making music: What causes musician’s dystonia? JAMA Neurology, 70(11), 1456–1459. https://doi.org/10.1001/jamaneurol.2013.3931

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hand-to-mouth-differences-between-musicians-hand-and-embouchure-dystonia/