Musician's dystonia

Cells that fire together, wire together. —Donald O. Hebb

Dystonia is an intriguing condition that is clinically and genetically heterogeneous, characterized by sustained, involuntary muscle contractions resulting in abnormal movements, irregular tremor, and twisting postures.¹ Focal dystonia, the most common form, is often task-specific and thus termed focal task-specific dystonia (FTSD). Specific learned motor tasks (such as writing or playing a musical instrument) trigger muscle spasms and interfere with performance while other actions are unaffected. Musicians are especially prone to FTSD due to their intense training and years of performing complex repetitive movements. FTSD has a frequency of 1:3,400 in the general population but 1:200 among musicians^2,3 and may be even higher, as musicians are often reluctant to seek help. Great pianists such as Robert Schumann in the 19th century and Leon Fleisher and Gary Graffman today have had FTSD and had to radically alter their performing careers. FTSD is often unrecognized, so musicians may learn of the disorder after years of symptoms. Fleisher, in an interview, said he aims to promote awareness of musician's dystonia and to reduce the fear that admitting to FTSD will shorten one's popularity or career.

FTSD may be caused by an exaggeration of normal mechanisms of brain plasticity. The postulated basis of task-driven changes in dystonia relates to the dynamic synapse concept of Hebb in which neuronal connectivity is modulated by activation. Plastic reorganization of the cortex has been demonstrated by augmentation of the finger projection areas after repetitive tasks, or with practice.⁴ While this may improve performance, it …