Brain Changes in Neuro-psychiatric Musicians Disorders

The Musical Dystonia (MD) is a neurological movement disorder in which the loss of coordination and control of the muscles in the game of the instrument comes. About 1-2% of professional musicians are affected. The cause of the disease is not yet clear.

In about 25% of cases, patients with MD have a dystonic movement disorder as well. First genes that may be associated with the disease have already been identified. Since this form of dystonia only occurs in people who make a lot of music, the question arises whether there are markers with which people can be identified who have a predisposition to develop an MD but are not affected. The Temporal Discrimination Threshold is one such biomarker that has already been established for other forms of dystonia. It specifies the shortest time interval in which two stimuli can be perceived separately.

The aim of the study is to establish the Temporal Discrimination Threshold as a biomarker of MD, which can be used to identify potential gene carriers and, in the long term, new causative genes of the disease. There will be included 20 patients each with an MD, healthy family members, healthy professional musicians and healthy non-musicians (ages 18-70).

Project leader: Prof. Dr. med. Alexander Schmidt, Prof. Dr. med. Andrea Kühn (Department of Neurology with Experimental Neurology)
Project implementation: Dr. med. Friederike Borngräber
Cooperation partner: Prof. Dr. med. Eckart Altenmüller (Institute for Music Physiology and Music Medicine Hannover)
The project is carried out as part of the research network DysTract:
www.research4rare.de/forschungsverbuende/dystract-3/
www.dystract.de

The musicians' dystonia (MD) is a neurological movement disorder characterised by the loss of coordination and control of the muscles while playing the instrument. About 1-2% of professional musicians are affected. The cause of the disease is not yet clear.
In recent years, the cerebellum has increasingly become the focus of interest in the pathogenesis. Thus, it could be shown that patients with a MD have reduced cerebellar activity. The aim of the study is to further characterize the extent of cerebellar dysfunction in MD and to investigate its modulability by electrical stimulation. It may be possible to derive a therapeutic benefit for the patients.
For the examination, professional pianists with MD (N = 15, ages 18-70) receive AC, DC, or placebo stimulation over the cerebellum on three days of measurement. By means of MIDI recordings and electroencephalographic recordings (EEG) the effect of stimulation on the piano playing and the electrical brain activity is examined.
Project leader: Prof. Dr. med. Andrea Kühn (Department of Neurology with Experimental Neurology), Prof. Dr. med. Alexander Schmidt
Project implementation: Dr. med. Friederike Borngräber
Cooperation partner: Prof. Dr. med. Eckart Altenmüller (Institute for Music Physiology and Music Medicine Hannover)
The project is carried out as part of the research network DysTract:
www.research4rare.de/forschungsverbuende/dystract-3/
www.dystract.de

Dr. Borngräber is funded in this project as BIH Charité Junior Clinician Scientist.

Performance anxiety is a frequent music-specific anxiety disorder, which is associated with a considerable psychosocial burden and impairment of the affected persons. In the medium to long term, the fear of the performance can often be well treated by psychotherapy; however, fast-acting, non-pharmacological treatment options are currently unavailable. However, scientific studies have shown that (special forms) of physical activity in other anxiety disorders already lead in the short term to a significant reduction in the disease-specific symptoms as well as biological correlates of an increased stress response (such as the stress hormone cortisol).

Against this background, we investigate in this study the effect of a six-day exercise program on the symptoms of onset anxiety as well as on psychological and biological parameters associated with or favoring an (increased) stress experience.

In a first examination, the diagnosis of a fear of the performance is ascertained, the severity of which is determined and stress-related psychological factors as well as the cortisol level determined. This is followed by a sports medicine examination to ensure the physical fitness of the participants and to determine the optimal individual training area. Afterwards, the participants will complete a standardized training of 20 minutes in a total of six times over a period of 12 days. Three or ten days after the end of the training period, a "performance exposure" will be held, in which the participants will each have a standardized stage performance in their respective musical discipline. In order to be able to determine the effects of the training on the fear of the performance and the stress experience, at different times after completion of the exercise program or before, during and after the appearance exposures, the severity of the occurrence anxiety and the stress-associated variables is examined again.

In this context, we are looking for professional musicians and music students from the age of 18, the
- suffer from an agoraphobia or suspicion of a fear of performing
- are not currently undergoing psychotherapeutic treatment

For further information on study participation please contact the study coordinator Ms. Jennifer Mumm.

Study director: Prof. Dr. med. Alexander Schmidt, Dr. med. Jens Plag
Study coordination: Dr. med. Isabel Fernholz, Psychological Psychotherapist Jennifer Mumm, M.Sc.

The study is financially supported by funds from the Friede Springer Foundation.