Botox may soothe ‘musician’s cramp’

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Injections of the wrinkle-banisher Botox may help soothe the involuntary muscle contractions that Plague some professional musicians, according to a new study.

Musicians are particularly susceptible to a condition known as focal task-specific dystonia, in which muscles affecting one part of the body—the hand, for instance—contract involuntarily during a particular activity. For musicians, that means suffering muscles spasms when they attempt to play their instruments—a potentially career-ending problem sometimes called ‘musician’s cramp.’

Hand dystonia, seen in musicians such as pianists, guitarists and string players, can cause the fingers to contract and curl under when the musician tries to perform. Another form of dystonia, embouchure dystonia, affects the muscles of the face, jaw and tongue in brass and woodwind players.

A number of treatment options exist, including oral medications, movement-based therapies and botulinum toxin type A—better known as Botox, one of its brand names. Though most often regarded as the enemy of frown lines, Botox has long been used to treat the uncontrolled muscle contractions that mark a number of medical conditions, such as cerebral palsy and chronic eye-muscle spasms.

Botox is a purified form of the toxin that causes botulism food poisoning. When injected in small doses, botulinum toxin helps relax spastic muscles by preventing nerve cells from releasing a chemical that triggers muscle contractions.

For the new study, published in the journal Neurology, researchers surveyed 84 German musicians with focal dystonia who had received injections of Dysport, a UK brand of botulinum toxin. The group included pianists, string players, guitarists and woodwind and brass players, most of whom had hand dystonia affecting one or two fingers.

Overall, 69 percent said they felt the treatment had helped them, with a majority saying they’d had a “noticeable improvement” in their performance. However, fewer patients—36 percent—reported a lasting improvement in their ability to perform.

Dr. Stephan Schuele of the Cleveland Clinic Foundation in Ohio led the study.

At the time of the survey, 24 of the 84 patients were still receiving botulinum toxin injections, having been treated for an average of 3 years. The fact that relatively few patients continued with the therapy illustrates the difficulty of treating focal dystonia in musicians, whose livelihood requires an “exquisite level of motor control,” according to an editorial published with the report.

Still, the study results are “encouraging,” write Drs. Seth L. Pullman and Anna H. Hristova of Columbia University Medical Center in New York.

They refer to the case of the famous pianist Leon Fleisher as a Botox “success story.” Hand dystonia had for 30 years limited Fleisher to playing compositions for the left hand, but since starting botulinum injections he has been able to expand to a two-handed repertoire.

A potential pitfall of the therapy is the muscle weakness it causes, Pullman and Hristova point out. Nearly all patients in the current study had some muscle weakness after their injections, which were given in the forearm in most cases.

Short-term weakness, the editorialists note, is to be expected, and for most patients with focal dystonia the side effect is not a problem. But it can be a serious obstacle for professional musicians with busy performance schedules.

SOURCE: Neurology, January 25, 2005.

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