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Secondary motor disturbances in 101 patients with musician’s dystonia
  1. Jaume Rosset-Llobet (26920jrl{at}
  1. Institut de Fisiologia i Medicina de l'Art-Terrassa, Spain
    1. Victor Candia (candia{at}
    1. Collegium Helveticum, University of Zurich and ETH Zurich, Switzerland
      1. Sílvia Fàbregas
      1. Institut de Fisiologia i Medicina de l'Art-Terrassa, Spain
        1. William J. Ray (wjr{at}
        1. Department of Psychology, Pennsylvania State University, United States
          1. Alvaro Pascual-Leone (apleone{at}
          1. Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical Scho, United States


            Objective: Musician’s focal dystonia is usually considered to be task specific but secondary motor disturbances have been reported as well. We carried out a detailed evaluation of the incidence of these secondary motor problems in 101 patients.

            Method: Symptoms were assessed using clinical histories, neurological examinations and observation of instrumental manoeuvres. Results: 53.5% of patients reported secondary motor disturbances in activities other than playing their main instrument, with the onset delayed, in some cases, by up to 12 years from the awareness of dystonic symptoms. 46.5% suffered from simple, 19.8% from complex, and 33.7% from progressive, cramps. Plucked string players (guitarists) mainly suffered from simple cramps while keyboardists more frequently displayed the progressive form. In all patients symptoms were focal, and the type of cramp was unrelated to the severity of the perceived symptoms. Those patients playing a second instrument similar to their main instrument showed symptoms which worsened to a higher degree than those playing either only one instrument, or whose second instrument was different.

            Conclusions: Longer follow-up assessments may reveal secondary motor symptoms that are not visible over shorter examination periods. Therefore, a throughout evaluation of everyday life motor activities should be considered in any clinical and treatment protocol. We speculate that the avoidance of movements that are similar to the main affected task may be of help in limiting symptoms. Consequently, focal dystonia may be considered more movement than task-specific.

            • focal dystonia
            • musician’s cramp
            • secondary motor symptoms

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