Focal dystonia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
G24 Dystonia
G24.3 Torticollis spasticus
G24.4 Idiopathic orofacial dystonia
G24.5 Blepharospasm
G24.8 Other dystonia
ICD-10 online (WHO version 2019)

The focal dystonia ( Greek  δυσ- dysplastic 'mis-' τόνος Tonos 'voltage') is one of the more common neurological disorders and manifests itself in uncontrollable and often long-lasting muscle contractions. The disorder is local and mostly affects regions that perform complex movements with extreme precision .

General

Focal dystonia is also known as a musician's cramp , employment cramp or employment neurosis. However, this refers to a special form of the disease, action-specific focal dystonia (also known as limb dystonia), which also includes writer's cramp and which is coded in the ICD-10 as F48.8.

This form of dystonia is characterized by the fact that the musculoskeletal system is generally intact, but when performing a learned movement such as the plucking movement on the guitar or the striking movement on the piano, the fingers or the hand are not able to perform this movement , while the same movement often runs smoothly without an instrument or in another context.

The causes that lead to disease are not known. However, one suspects a disturbance of the unconscious regulation of the motor skills in the area of ​​the basal ganglia in the brain. According to one theory, the individual centers of the image in the motor cortex are enlarged to the extent that the regions overlap and thus adjacent motor functions are triggered. The middle finger is supposed to move, but the ring finger is also activated, the ring finger is called back, and at the same time activates the middle finger, thus creating a vicious circle of movement initiation and inhibition .

Other forms of focal dystonia are:

frequency

The incidence rate for musicians is 1: 200 to 1: 500, for other professional groups such as surgeons or precision mechanics it is 1: 3,400 cases per year. For the general population, the incidence of the disease is around 1: 40,000.

Therapy and prophylaxis

These therapies are usually used:

  • Release of botulinum toxin . This agent can be injected into certain muscle regions, it inhibits the excessively strong muscle tractions, which leads to "normal" motor skills. However, the treatment must be repeated regularly, as the effect wears off after the agent has broken down in the body (about 3 months). Sometimes this repetition leads to the formation of antibodies that make further treatment ineffective.
  • Retraining: Through targeted exercises, it is possible to desensitize the misdirected motor skills and to recalibrate the motor skills.
  • A combination of both therapies: with delivery of botox and retraining therapy.
  • For some musicians, thin gloves improve symptoms, presumably by reducing the sensation of touch.

As the causes of focal dystonias are not known, specific prophylaxis is not possible.

forecast

Symptoms decrease in around 10–20% of those affected. This usually takes place within the first three years. However, symptoms can recur.

In the other patients, slow worsening is common within three to five years and then moving to a stable situation.

Occupational disease

Since August 1, 2017, focal dystonia as a disease of the central nervous system in instrumental musicians due to high-intensity fine motor activity has been included in the list of occupational diseases of the statutory accident insurance in Germany (number 2115 of Appendix 1 to the Occupational Diseases Ordinance - BKV). It can thus be recognized as an occupational disease in professional musicians . This also applies to illnesses that occurred before this date ( Section 6 (1) BKV).

See also

Sources and individual references

  1. ↑ A. Müller, RW Schlecht, Alexander Früh, H. Still: The way to health: a faithful and indispensable guide for the healthy and the sick. 2 volumes, (1st edition 1901, 3rd edition 1906, 9th edition 1921) 31st to 44th edition. CA Weller, Berlin 1929 to 1931, Volume 2 (1929), p. 22 f. ( The typing cramp and related "employment cramps" ).
  2. ^ J. Paulig, HC Jabusch u. a .: Sensory trick phenomenon improves motor control in pianists with dystonia: prognostic value of glove effect. In: Frontiers in psychology. Volume 5, 2014, ISSN  1664-1078 , p. 1012, doi : 10.3389 / fpsyg.2014.01012 , PMID 25295014 , PMC 4172087 (free full text).

literature

  • Eckart Altenmüller : Focal dystonia in musicians: a challenge for musicians medicine. in: Musikphysiologie und Musikermedizin 3 (1996), pp. 29-40
  • Jochen Blum (ed.): Medical problems with musicians . Thieme, Stuttgart 1995, ISBN 3-13-100281-6
  • Renate Klöppel: The health book for musicians . Gustav Bosse, Kassel 1999, ISBN 3-7649-2445-4
  • A. Lahme, S. Klein-Vogelbach, I. Spirgi-Gantert: Occupational illnesses in musicians . Springer, Berlin, Heidelberg 2000, ISBN 3-540-67115-3
  • Christoph Wagner: hand and instrument. Basics of music physiology. Practical consequences . Breitkopf & Härtel, Wiesbaden a. a. 2005, ISBN 3-7651-0376-4