Optimal botulinum toxin therapy of dystonia in Germany: what would it cost?

Botulinum toxin (BT) therapy is the therapy of choice for most forms of dystonia. We want to describe its costs, if all dystonia patients in Germany would have access to optimal BT therapy. For this, we combined the latest data on epidemiology of dystonia and dosing of BT therapy for dystonia.

Acquisition of musical skills and abilities in older adults-results of 12 months of music training.

Background: Older adults can acquire new skills across different domains. Practicing a musical instrument has been identified as a promising activity for improving cognition, promoting well-being, and inducing brain plasticity in older individuals. However, the mechanisms of these changes are still poorly understood.

Effects of a 1-year piano intervention on cognitive flexibility in older adults.

We analyzed the data of a randomized controlled trial to examine the effects of piano practice on cognitive flexibility in healthy older adults. Participants ( = 153, 69.5 ± 3.

The impact of fine motor activities like playing musical instruments on the thickness and strength of the flexor digitorum muscle.

Background: This study aimed to explore the impact of occupational activities involving extensive finger movement on the muscular characteristics of the forearms. In particular, the flexor digitorum (FD) muscular thickness and strength asymmetry between right and left hand were compared between musicians and non-musicians.

Methods: Ultrasonography was employed to measure the thickness of the FD in each hand, while a validated custom-made device was used to assess the strength of the flexor and extensor digitorum (ED).

Stress in Musicians with and Without Focal Dystonia Is Not Reflected in Limbic Circuit Activation.

Background: Musicians' dystonia (MD) is a movement disorder with several established risk factors, but the exact pathophysiology remains unknown. Recent research suggests dysfunction in sensory-motor, basal ganglia, cerebellar, and limbic loops as potential causes. Adverse childhood experiences are also considered risk factors.

Video-based diagnosis support system for pianists with Musician's dystonia.

Background: Musician's dystonia is a task-specific movement disorder that deteriorates fine motor control of skilled movements in musical performance. Although this disorder threatens professional careers, its diagnosis is challenging for clinicians who have no specialized knowledge of musical performance.

Objectives: To support diagnostic evaluation, the present study proposes a novel approach using a machine learning-based algorithm to identify the symptomatic movements of Musician's dystonia.

Factors Associated with Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools.

Purpose: We aimed to evaluate factors associated with performance-related pain among musicians with different backgrounds, comparing music students and professional musicians.

Methods: We performed a multicenter cross-sectional study in a stratified random sample consisting of music students (294) and professional musicians (291). The main outcome was performance-related pain (PRP), measured by the Performance-related Pain among Musicians Questionnaire (PPAM).

Incobotulinum Toxin-A in Professional Musicians with Focal Task-Specific Dystonia: A Double Blind, Placebo Controlled, Cross-Over Study.

Background: Musician's focal task-specific dystonia is a complex disorder of fine motor control, with incomplete understanding of its etiology. There have been relatively few trials of botulinum toxin in upper limb task-specific dystonia, and prior studies have yielded variable results, leading to skepticism regarding the utility of this approach in elite performers.

Methods: We conducted a double-blind, placebo-controlled, randomized, cross-over study of incobotulinum toxin-A in 21 professional musicians with focal upper extremity task-specific dystonia affecting performance on their instrument, using a novel paradigm of initial injections followed by booster injections at two- and four-week intervals.

Comparison of Perfectionism Between Music and Medical Students and its Association with Anxiety.

Objectives: Perfection is a central goal for many musicians and health professionals. The present study compared perfectionism between music and medical students to examine whether perfectionism is adaptive or maladaptive and how it evolves during university studies. Furthermore, the association between perfectionism and anxiety was investigated in both populations to determine possible implications for mental and general health.

Performance-related pain and disability among music students versus professional musicians: a multicenter study using a validated tool.

Objective: To evaluate prevalence of performance-related pain among musicians and compare pain characteristics, associated disability and approach to pain management, between music students and professional musicians.

Methods: A multicenter cross-sectional study was performed in a multi-stage stratified cluster random sample of 585 musicians, stratified by music students (294, among which 234 were at pre-university level and 60 at university level) and professional musicians (291). The main outcome was performance-related pain, measured by Performance-related Pain among Musicians Questionnaire (PPAM).

What Does It Take to Play the Piano? Cognito-Motor Functions Underlying Motor Learning in Older Adults.

The acquisition of skills, such as learning to play a musical instrument, involves various phases that make specific demands on the learner. Knowledge of the cognitive and motor contributions during learning phases can be helpful in developing effective and targeted interventions for healthy aging. Eighty-six healthy older participants underwent an extensive cognitive, motoric, and musical test battery.

Gender Differences in Task Specific Dystonia: What Can we Learn from Musician's Dystonia?

Background: Musician's Dystonia (MD) is a task specific, focal dystonia which usually occurs only at the instrument. The pathophysiology is not fully understood, but several risk factors like over-practice and genetic predisposition are known. Interestingly, 80% of those affected are men, which stands in contrast to the gender distribution in other focal dystonias, such as cervical dystonia.

Large-Scale Screening: Phenotypic and Mutational Spectrum in Isolated and Combined Dystonia Genes.

Background: Pathogenic variants in several genes have been linked to genetic forms of isolated or combined dystonia. The phenotypic and genetic spectrum and the frequency of pathogenic variants in these genes have not yet been fully elucidated, neither in patients with dystonia nor with other, sometimes co-occurring movement disorders such as Parkinson's disease (PD).

Objectives: To screen >2000 patients with dystonia or PD for rare variants in known dystonia-causing genes.

Increased functional connectivity in the right dorsal auditory stream after a full year of piano training in healthy older adults.

Learning to play an instrument at an advanced age may help to counteract or slow down age-related cognitive decline. However, studies investigating the neural underpinnings of these effects are still scarce. One way to investigate the effects of brain plasticity is using resting-state functional connectivity (FC).

Performance-Related Pain Among Musicians Questionnaire (PPAM): Multicenter Validation of the First Questionnaire to Evaluate Performance-Related Pain Among Musicians With Different Musical Backgrounds.

We aim to present the first psychometric evaluation of the Performance-related Pain Among Musicians questionnaire (PPAM), the first questionnaire specifically designed to evaluate performance-related pain among musicians with different musical backgrounds, based on a multicenter validation study. The psychometric evaluation was performed in a validation sample of 458 musicians, at baseline and after seven days. We assessed the applicability, reliability, internal consistency, construct validity, and factor structure of the PPAM.

Practice behaviors as trigger factor for the onset of Musicians' Dystonia.

Musician's Dystonia (MD) is a task-specific movement disorder that results in an involuntary cramping of muscles involved in playing an instrument such as the upper limbs or the embouchure. It is usually painless and occurs in general only at the instrument. The pathophysiology of MD is not completely understood.

Development and Initial Validation of the First Questionnaire to Evaluate Performance-related Pain Among Musicians with Different Backgrounds: Performance-related Pain Among Musicians Questionnaire (PPAM).

Aim: To develop and perform the expert's content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds.

Methods: The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts' panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain.

Effect of manual therapy on music students with playing-related musculoskeletal disorders: a prospective study.

Playing Related Musculoskeletal Disorders (PRMD) belong to the most prevalent medical ailments affecting musicians' health and career. This study documents the effect of a physiotherapeutic treatment as well as functional impairments of PRMD on the musculoskeletal system. In total, 32 music students suffering from PRMD were examined in Hanover Medical School (MHH) before and after they received twelve physiotherapeutic treatments, which were carried out over 20 min each over 6 weeks.

Musical Expertise and Executive Functions in Experienced Musicians.

Extensive music practice has been suggested to enhance the development of cognitive abilities over and above musical expertise. Executive functions (EFs) have been particularly investigated, given their generalizability across different domains and their crucial role in almost all aspects of cognition. However, the relationship between musical expertise and EFs is still not completely understood, as several studies have reported conflicting results.

Embouchure Dystonia as a Network Disease.

While the pathophysiology of embouchure dystonia, a sub-entity of musician's dystonia, is still not fully understood, recent research has shown that it involves alterations of several brain functions and networks. Maladaptive plasticity in sensorimotor integration, sensory perception, and deficient inhibitory mechanisms at cortical, subcortical, and spinal level seem to contribute to its pathophysiology. Furthermore, functional systems of the basal ganglia and the cerebellum are involved, clearly pointing toward a network disorder.

Focal Dystonia and the Stress Network: The Role of Stress Vulnerability and Adverse Childhood Experiences in the Development of Musician's Dystonia.

Musician's dystonia is often described as a neurological disorder, resulting from reduced inhibition in the basal ganglia and the cerebellum and dysfunctional cortical plasticity. However, several studies over the last decades support the hypothesis that psychological factors play an important role in the aetiology of dystonia, contradicting its classification as "purely neurological". Especially adverse childhood experiences (ACEs) such as neglect, maltreatment, or household dysfunction may influence the sensorimotor system, additionally to the impact they have on psychological traits.

Acute Neuromuscular Fatigability and Perceived Exertion in High-Level University Pianists: An Electromyography and Maximum Force Capacity Study.

Purpose: Musicians are labelled 'fine motor athletes' due to the significant demands of practice and performance. In response, sports medical concepts and expertise have been adapted and mobilized to address musicians' health considerations. However, understanding distinct differences between the sports and performing arts medical contexts is critical.

Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia.

The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both parameters, a group of 12 musicians diagnosed with focal hand dystonia was compared with a group of 12 healthy matched musicians. The minimum and maximum times since the last injection across patients were 0.