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Nervenheilkunde 2018; 37(10): 667-678
DOI: 10.1055/s-0038-1673596
Musikermedizin
Georg Thieme Verlag KG Stuttgart · New York

Musikerdystonien

Phänomenologie, Ursachen, Differenzialdiagnosen und BehandlungsmöglichkeitenMusicians’ dystonia
E. Altenmüller
1   Hochschule für Musik, Theater und Medien Hannover, Institut für Musikphysiologie und Musiker-Medizin, Hannover
,
A. Lee
2   Abteilung Neurologie, Klinikum rechts der Isar, München
,
H.-C. Jabusch
3   Hochschule für Musik Dresden Carl Maria von Weber, Institut für Musikermedizin, Dresden
› Author Affiliations
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Publication History

eingegangen am: 20 June 2018

angenommen am: 11 July 2018

Publication Date:
04 October 2018 (online)

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Zusammenfassung

Musizieren auf professionellem Niveau ist eine der komplexesten menschlichen Leistungen. Extrem schnelle und komplexe, zeitlichräumlich präzis definierte Bewegungsmuster müssen mit hoher Zuverlässigkeit gelernt, gespeichert und abgerufen werden, um die Erwartungen der Zuhörer zu erfüllen. Um diese Fähigkeiten zu erwerben, müssen Musiker über viele Jahre hinweg intensiv üben. Steigende Arbeitsbelastung am Instrument kann zu maladaptiver Plastizität des Zentralnervensystems führen und motorische Störungen, wie z. B. die Musikerdystonie auslösen. Die Musikerdystonie ist durch den permanenten Verlust der Kontrolle hoch präziser Bewegungen beim Spielen eines Musikinstruments gekennzeichnet. Sie betrifft etwa 1–2% der Berufsmusiker. Pathophysiologisch liegen gestörte Inhibition und sensomotorische Integration, möglicherweise auf dem Boden einer genetischen Veranlagung vor. Als „dynamisches Stereotyp” wird eine zunächst vorübergehende Verschlechterung der Feinmotorik bezeichnet, die häufig durch psychologische Stressoren oder Müdigkeit ausgelöst wird und als Vorform der Dystonie betrachtet werden kann.

Die Behandlung der motorischen Störungen bei Musikern umfassen ergonomische Anpassungen, Anticholinergika, Retraining, und lokale Injektionen mit Botulinumtoxin. Präventionsstrategien in der Ausbildung junger Berufsmusiker sollten auf ein gesundes Arbeitsverhalten, Selbstmanagement, und psychologisch unterstützenden Unterricht ausgerichtet sein.

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.

Schlüsselwörter

Musikerdystonie - Pathophysiologie - Dynamisches Stereotyp - Behandlung - Botulinumtoxin - Retraining

Keywords

Musicians’ dystonia - pathophysiology - dynamic stereotype - treatment - botulinum toxin - retraining
 

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