Musikerdystonien: Phänomenologie, Ursachen, Differenzialdiagnosen und Behandlungsmöglichkeiten

Summary Performing music at a professional level is probably one of the most complex human accomplishments. Extremely fast and complex, temporo-spatially predefined movement patterns have to be learned, memorized, and retrieved with high reliability in order to meet the expectations of listeners. To acquire these skills, musicians must undergo extensive training periods over many years, which start in early childhood and continue on through stages of increasing physical and strategic complexities. Increasing work-load my lead to maladaptive plastic adaptations and trigger motor disturbances, such as musicians' dystonia (MD). MD, which is characterized by the permanent loss of control of highly skilled movements when playing a musical instrument, is the gravest manifestation of dysfunctional motor programs, frequently linked to a genetic susceptibility to develop such motor disturbances. A predystonic syndrome, termed Dynamic Stereotype is characterized by temporary deterioration of fine motor control, frequently triggered by anxiety or fatigue. Treatment of the different forms and degrees of motor disturbances include ergonomic adaptations, anticholinergic drugs, retraining and local injections with botulinum toxin. Prevention strategies, implemented in the training of young professional musicians may target predominantly healthy working behaviour, self, management and psychologically supportive teaching.