Focal dystonia in woodwind instrumentalists: Long-term outcome

This study was conducted to describe the clinical characteristics and long-term outcome in woodwind instrumentalists with focal dystonia. Occupational cramp in musicians has been recognized for 150 years, but only in the past two decades has there been a resurgence of interest in this problem. Despite its overall rarity, the diagnosis of focal dystonia is made in a substantial number of instrumental musicians seeking care for playing-related problems, ranging from 5% to 14% in three larger series. The authors present the clinical characteristics and the results of a follow-up survey of 24 woodwind instrumentalists with focal dystonia seen at their institution between 1987 and 2001. Of the 24 musicians, 15 were male, 9 female. Mean age at onset was 34 years (range 18 to 56 years). Duration of symptoms on presentation averaged 3.5 years. Of the 24, 20 were professional musicians, three music students, and one amateur. Fifteen musicians (63%) responded to the written questionnaire, another five were assessed on subsequent visits, and four were lost to follow-up. The questionnaire was administered on average 7.1 years after initial presentation. Long-term information was available on average 8.5 years after the initial onset of symptoms. The main complaint was "impaired control" of movements, in 18 (75%) affecting the limb and in six (25%) the muscles of embouchure. Four patients (22%) with limb and two (33%) with embouchure dystonia had spreading of the dystonia to other activities. In 77% of the patients abnormal involuntary movement and posturing were noted during playing the instrument. Three patients with limb dystonia experienced moderate benefit from anticholinergic treatment, in two combined with botulinum toxin injections. Another four patients indicated benefit from splinting or incidental casting of their limb. Two patients with embouchure dystonia benefited from rebuilding their embouchure. Overall, half of the patients were unable to pursue their careers as professional musicians, in equal proportions in the two groups. Focal dystonia may affect the limb or muscles of embouchure in woodwind instrumentalists. Available treatment is often of little value, and in half of the patients the dystonia leads to the end of the musical career. More effective approaches are badly needed.