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Focal Dystonia

This is a not so rare disease among musicians, which has serious consequences for instrumental playing. Single muscle parts, e.g. the mouth of brass players or the fingers of pianists, suddenly seem to stop obeying. Focal dystonia can acutely threaten the professional career. Therefore, the syndrome is very feared by all musicians.

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The Focal Dystonia

"In adolescence, Robert Schumann first noticed that the index finger and the middle finger had noticeably less strength and flexibility than the others. The prolonged use of a machine ("cigar mechanism"), by means of which the affected fingers were held strongly behind the back of the hand, resulted in that they fell into a state of paralysis from now on, to the extent that, firstly, they had only a weak feeling and, secondly, they were no longer subject to the will with regard to movement. " Schumann himself wrote in his diary on June 14, 1832: "The third finger is completely stiff."

Robert Schumann probably suffered from a focal dystonia, a movement disorder with loss of fine motor control after years of practiced movements on the instrument. This is usually associated with no pain, occurs in 1-2% of all professional musicians between the age of 30 and 40 years, and can lead to serious impairment of instrumental performance and - finally disability.

Frequently violinists and wind players as well as pianists and also guitar players are concerned. Specific risk factors include i.a. a high workload on the instrument, classical music, male gender and a genetic predisposition. Often there is also a psychological sensitivity to anxiety disorders and perfectionism. The causes are not yet finally resolved. An inhibition deficit of motor centers in the brain is suspected.

The therapy is difficult and usually tedious. Botulinum toxin and trihexyphenidyl are used at the drug level as well as retraining and ergonomic modifications to the device, but treatment has not been satisfactory. Almost 30% of all affected musicians have to give up their profession. Robert Schumann also had to end his career as a pianist. Since 2017 the disease is recognized as an occupational disease.