Focal dystonia

Focal dystonia is a neurological condition affecting a muscle or muscles in a part of the body causing an undesirable muscular contraction or twisting. For example, in focal hand dystonia, the fingers either curl into the palm or extend outward without control.

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Causes

This is thought to be caused by misfiring of neurons, causing the contractions. Although the condition expresses itself in a body part, it is believed to originate in the sensorimotor cortex, a thin layer of neural tissue covering the brain that is essentially a "map" of the human body. Under normal conditions, discrete body parts (such as the individual fingers) occupy their own specified areas on the sensorimotor cortex. Brain imaging technology has revealed that these areas become "blurred" on the cortex of an individual with dystonia. Thus, the brain cannot effectively differentiate the distinct digits, and errant nerve impulses--telling the wrong muscles to contract--ensue. While usually painless, there are some instances when the condition does indeed cause pain for the patient--usually through sustained contraction and abnormal posturing. Focal dystonia most typically affects those who rely on fine motor skills - musicians, writers, surgeons, etc.^{[citation needed]} It is generally "task specific," meaning that it is only problematic during certain activities.

Notable cases

Musicians affected by focal dystonia include Leon Fleisher, of the Peabody Conservatory of Music, who had suffered from this affliction in his right hand, as did Alex Klein, formerly the first oboist of the Chicago Symphony, and Ernestine Whitman, former member of the Atlanta Symphony and currently a professor of flute at Lawrence University. Former principal tuba of the New York Philharmonic, Warren Deck was diagnosed with focal dystonia of the upper lip in 2001, ending his playing career. In 2005, New Age acoustic guitarist Billy McLaughlin announced via his website that he is suffering from focal dystonia, which severely limits his ability to play. Another musician to be afflicted by this condition is shred guitarist Terry Syrek, who recorded his entire album "AUM" with just two fully functioning fingers of his fret hand. Classical guitarist David Leisner is another musician who has fully recovered from this condition and who has returned successfully to the concert stage and recording studio in the early 1990s after a decade of disability. A well known bass guitarist, Andy Billups who plays with british rock act The Hamsters has also made a partial recovery from this disorder and continued to play by using modified guitar plectrums to make up for the limited function of his right hand.

Focal dystonia has been identified as the cause of a common affliction in the game of golf known as the “yips”. The yips are most commonly associated with putting, and renowned golf coach Hank Haney has written a book specific to the subject in his 2007 “Fix the yips forever”. He is best known as the current coach of world number one player Tiger Woods. Haney goes on to explain in his book that the yips are not restricted to putting but are also a common, although often undiagnosed, problem amongst advanced players for putting as well as what he calls "chipping yips" and "full swing yips".

Scott Adams, the writer of the popular Dilbert comics, is also afflicted with focal dystonia of the hand, which impedes his artwork.^[1]

Treatment

This condition can often be treated with injections of botox, a commercially prepared form of botulinum toxin. This treatment has aided many afflicted performers, including pianist Leon Fleischer (Fleischer had previously explored a variety of treatments - including acupuncture and rolfing - to no avail). Botox is injected at the neuromuscular junction to prevent release of the neurotransmitter acetylcholine, which normally causes muscle contraction. Botox merely targets the symptoms of the disorder and is not a cure for dystonia. Since the root of the problem is neurological, it is thought that sensorimotor retraining activities can enable the brain to "rewire" itself in a manner that can ultimately eliminate dystonic movements.

References

Sources

• Rich, Robert F.; Mackin, Evelyn; Callahan, Anne; A. Lee Osterman; Terri M. Skirven; Schneider, Lawrence J.. Hunter, Mackin & Callahan's Rehabilitation of the Hand and Upper Extremity (2 Volume Set). St. Louis: Mosby, 2053–2075 ("Focal Hand Dystonia"). ISBN 0-323-01094-6. 

• Leisner, David. "Curing Focal Dystonia or How to Play the Guitar with Large Muscles." Guitar Review 133 (2007): 10–15.

• Pascual-Leone A (2001). "The brain that plays music and is changed by it". Ann. N. Y. Acad. Sci. 930: 315–29. PMID 11458838.

• Solomon, Jason W. "What Every Guitarist Should Know: A Guide to the Prevention and Rehabilitation of Focal Dystonia." Guitar Review 133 (2007): 2–9.