Neuropsychological Aspects of Focal Dystonia in Musicians

Musician’s dystonia (MD) is a focal, task-specific neurological movement disorder that presents with loss of voluntary motor control when playing the instrument and affects up to 1–2 % of professional musicians. The current pathophysiological understanding of MD is that of a network disease, involving the sensorimotor cortex, basal ganglia, cerebellum and the limbic system. Various extrinsic factors, e.g. high temporal and spatial sensorimotor constraints on the instrument or more than 10 000 hours of accumulated practice time, as well as intrinsic factors, e.g. high levels of anxiety and perfectionism, and even genetic factors have been identified to increase the risk to develop MD. From a neuropsychological point of view, two phenotypes of MD can be distinguished with high or low psychological stress, which should be taken into account to adapt the individual therapy. Treatment options for MD include medication with trihexyphenidyl, local injections of botulinum toxin A, retraining, ergonomic changes of the instrument, and in patients with high psychological stress also antidepressants and behavioral therapy.