Zusammenfassung
Einleitung: Musikerdystonien sind durch einen schmerzfreien Verlust der feinmotorischen Koordination lang eingeübter Bewegungsfolgen gekennzeichnet. Als Pathomechanismen werden die Fusion vergrößerter kortikaler sensomotorischer Repräsentationen oder eine Störung der lateralen Hemmung in kortikalen und subkortikalen Schaltkreisen diskutiert. Um die Pathophysiologie der Erkrankung weiter aufzuklären wurden bewegungskorrelierte kortikale Potenziale (MRCPs) bei dystonen Musikern und bei gesunden Kontrollen abgeleitet. Methode: Neun Musiker mit einseitiger fokaler Hand-Dystonie wurden gesunden Musikern sowie einer Kontrollgruppe von Nicht-Musikern gegenübergestellt. Es wurden MRCPs von 11 Elektrodenpositionen über bilateralen sensomotorischen Rindenfeldern abgeleitet. Die Bewegungsaufgaben bestanden a) im Anschlag eines einzigen Tones mit dem Zeigefinger und b) in der Ausführung einer komplexen Bewegungssequenz auf einem Steinway-Flügel. Ergebnisse: Gesunde Musiker zeigten bei der komplexen Aufgabe gegenüber Nicht-Musikern eine stärkere Aktivierung der prämotorischen Region vor Bewegungsbeginn und reduzierte motorische Potenziale. Patienten zeigten gegenüber Musikern nur bei Ausführung der Aufgabe mit der betroffenen Hand eine erhöhte späte NS'-Komponente vor Bewegungsbeginn. Diskussion: Die veränderten Aktivierungsmuster von gesunden Musikern passen zum Konzept der übungsinduzierten Plastizität mit funktioneller und struktureller Vergrößerung relevanter kortikaler Areale. Bei dystonen Musikern kann die übermäßige Aktivierung supplementär-motorischer Areale vor Bewegungsbeginn für eine defiziente Inhibition in kortikalen-subkortikalen Erregungsschleifen sprechen. Schlussfolgerung: Bei Musikern mit fokalen Dystonien zeigen MRCPs in einem aufgabenspezifischen Kontext eine gestörte kortikale Inhibition vor Bewegungsbeginn.
Abstract
Introduction: Musician's focal dystonia is characterised by a painless loss of muscular control in highly overpracticed skilled movements. Fusion of enlarged cortical sensory-motor representations and loss of inhibitory neuronal interactions are discussed as underlying pathology. In order to clarify which of these mechanisms contributes, movement related cortical potentials (MRCPs) were recorded in dystonic musicians and healthy controls. Methods: Nine right handed dystonic musicians were compared to an age matched group of healthy musicians and to a group of non-musician controls. MRCPs were recorded from 11 electrode locations placed over the sensorimotor cortex. Subjects had to play (i) a single note and (ii) a complex motion pattern. All tasks were to execute on a grand piano. Results: Musicians compared with non-musicians showed higher premovement activity and a reduced motor potential in the complex task. The activation pattern in the patients depended on the performing hand. Compared to healthy musicians, task performance of the dystonic hand was characterised by higher premovement potentials especially of the late NS' component. Discussion: The results demonstrate use-dependent cortical plasticity in musicians compared to non-musicians controls. In musicians' dystonia, the premotor and sensorimotor cortex, rather then being inhibited as indicated by recent MRCP studies, may be overactive during movement preparation with the affected hand when tested in a task-specific realistic scenario. Conclusion: MRCPs in task-specific context reveal reduced inhibition in dystonic musicians.
Key words
Musician's cramp - focal dystonia - movement related cortical potentials - skilled movements - motor systems
Literatur
-
1 Ostwald P F. Glenn Gould: The Ecstasy and Tragedy of Genius. New York; W. W. Norton & Company 1998
-
2 Altenmüller E. Das Ende vom Lied: Schumanns Verstummen am Klavier. In: Seither C (Hrsg) Tacet-Non Tacet-Festschrift für Peter Becker. Saarbrücken; Pfau-Verlag 2004: 234-256
-
3 Altenmüller E. Fokale Dystonie. In: Nelle G, Mauritz H (Hrsg) Neurologische Rehabilitation. Stuttgart; Thieme Verlag 2004 (im Druck)
-
4
Altenmüller E.
Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians.
Hand Cli.
2003;
19
523-538
-
5
Byl N N, McKenzie A.
Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study.
J Hand Ther.
2000;
13
289-301
-
6
Fletcher N A, Harding A E, Marsden C D.
The relationship between trauma and idiopathic torsion dystonia.
J Neurol Neurosurg Psychiatry.
1991;
54
713-717
-
7
Hallett M.
Dystonia: abnormal movements result from loss of inhibition.
Adv Neurol.
2004;
94
1-9
-
8
Nakashima K, Rothwell J C, Day B L, Thompson P D, Shannon K, Marsden C D.
Reciprocal inhibition between forearm muscles in patients with writer's cramp and other occupational cramps, symptomatic hemidystonia and hemiparesis due to stroke.
Brain.
1989;
112 (Pt 3)
681-697
-
9
Rosenkranz K, Altenmüller E, Siggelkow S, Dengler R.
Alteration of sensorimotor integration in musician's cramp: impaired focusing of proprioception.
Clin Neurophysiol.
2000;
111
2040-2045
-
10
Mink J W.
The basal ganglia: focused selection and inhibition of competing motor programs.
Prog Neurobiol.
1996;
50
381-425
-
11
Bara-Jimenez W, Shelton P, Sanger T D, Hallett M.
Sensory discrimination capabilities in patients with focal hand dystonia.
Ann Neurol.
2000;
47
377-380
-
12
Lim V K, Altenmüller E, Bradshaw J L.
Focal dystonia: Current theories.
Hum Mov Sci.
2001;
20
875-914
-
13
Bara-Jimenez W, Catalan M J, Hallett M, Gerloff C.
Abnormal somatosensory homunculus in dystonia of the hand.
Ann Neurol.
1988;
44
828-831
-
14
Elbert T, Candia V, Altenmüller E, Rau H, Rockstroh B, Pantev C, Taub E.
Alteration of digital representations in somatosensory cortex in focal hand dystonia.
Neuroreport.
1998;
9
3571-3575
-
15
Byl N N, Merzenich M M, Jenkins W M.
A primate genesis model of focal dystonia and repetitive strain injury: Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.
Neurology.
1996;
47
508-520
-
16
Quartarone A, Bagnato S, Rizzo V. et al .
Abnormal associative plasticity in the human motor cortex in writer's cramp.
Brain.
2003;
126
2586-2596
-
17
Deuschl G, Toro C, Matsumoto J, Hallett M.
Movement-related cortical potentials in writer's cramp.
Ann Neurol.
1995;
38
862-868
-
18
Munte T F, Altenmüller E, Jancke L.
The musician's brain as a model of neuroplasticity.
Nat Rev Neurosci.
2002;
3
473-478
-
19
Oldfield R C.
The assessment and analysis of handedness: the Edinburgh inventory.
Neuropsychologia.
1971;
9
97-113
-
20
Drescher D, Parlitz D, Tiedemann J, Altenmüller E.
Ein neues Messinstrument zur Bestimmung und Darstellung von Fingerkräften auf der Klaviertastatur.
Europiano.
1999;
2
23-28
-
21
McCarthy G, Wood C C.
Scalp distributions of event-related potentials: an ambiguity associated with analysis of variance models.
Electroenceph clin Neurophysiol.
1985;
62
203-208
-
22
Hallett M.
Movement-related cortical potentials.
Electromyogr Clin Neurophysiol.
1994;
34
5-13
-
23
Amunts K, Schlaug G, Schleicher A. et al .
Asymmetry in the human motor cortex and handedness.
Neuroimage.
1996;
4
216-222
-
24
Elbert T, Pantev C, Wienbruch C, Rockstroh B, Taub E.
Increased cortical representation of the fingers of the left hand in string players.
Science.
1995;
270
305-307
-
25
Krings T, Topper R, Foltys H. et al .
Cortical activation patterns during complex motor tasks in piano players and control subjects. A functional magnetic resonance imaging study.
Neurosci Lett.
2000;
278
189-193
-
26
Hund-Georgiadis M, Cramon D Y von.
Motor-learning-related changes in piano players and non-musicians revealed by functional magnetic-resonance signals.
Exp Brain Res.
1999;
125
417-425
-
27 Altenmüller E, Gerloff C. Psychophysiology and the EEG. In: Niedermeyer E, Lopes da Silva F (eds) Electroencephalography. Baltimore; Williams and Wilkins 1998: 637-655
-
28
Gerloff C, Corwell B, Chen R, Hallett M, Cohen L G.
Stimulation over the human supplementary motor area interferes with the organization of future elements in complex motor sequences.
Brain.
1997;
120 (Pt 9)
1587-1602
-
29
Shibasaki H, Sadato N, Lyshkow H. et al .
Both primary motor cortex and supplementary motor area play an important role in complex finger movement.
Brain.
1993;
116 (Pt 6)
1387-1398
-
30 Rockstroh B, Elbert T, Canavan A, Lutzenberger W, Birbaumer N. Slow cortical potentials and behaviour. Baltimore; Urban und Schwarzenberg 1989
-
31
Jones R D, Donaldson I M, Parkin P J.
Impairment and recovery of ipsilateral sensory-motor function following unilateral cerebral infarction.
Brain.
1989;
112 (Pt 1)
113-132
-
32
Colebatch J G, Gandevia S C.
The distribution of muscular weakness in upper motor neuron lesions affecting the arm.
Brain.
1989;
112 (Pt 3)
749-763
-
33
Lang W, Zilch O, Koska C, Lindinger G, Deecke L.
Negative cortical DC shifts preceding and accompanying simple and complex sequential movements.
Exp Brain Res.
1989;
74
99-104
-
34
Chen R, Cohen L G, Hallett M.
Role of the ipsilateral motor cortex in voluntary movement.
Can J Neurol Sci.
1997;
24
284-291
-
35
Kamp K W Van der, Rothwell J C, Thompson P D, Day B L, Marsden C D.
The movement-related cortical potential is abnormal in patients with idiopathic torsion dystonia.
Mov Disord.
1995;
10
630-633
-
36
Yazawa S, Ikeda A, Kaji R. et al .
Abnormal cortical processing of voluntary muscle relaxation in patients with focal hand dystonia studied by movement-related potentials.
Brain.
1999;
122 (Pt 7)
1357-1366
-
37
Pujol J, Roset-Llobet J, Rosines-Cubells D. et al .
Brain cortical activation during guitar-induced hand dystonia studied by functional MRI.
Neuroimage.
2000;
12
257-267
Univ.-Prof. Dr. med. Eckart Altenmüller
Institut für Musikphysiologie und Musiker-Medizin · Hochschule für Musik und Theater Hannover
Hohenzollernstraße 47
30161 Hannover
Email: altenmueller@hmt-hannover.de
