Quantification of focal dystonia in pianists using scale analysis.

Focal dystonia in pianists is a task-specific movement disorder that causes loss of pianistic skills and provokes irregularities in playing. So far, no method has been available for objective quantification of the disorder. Eight professional pianists with focal dystonia and eight healthy professional pianists matched by age, gender, and handedness were examined, using a newly developed MIDI-based Scale Analysis as well as the Arm Dystonia Disability Scale (ADDS). Key velocities and timing parameters were analyzed. In 5 pianists with dystonia, follow-up examinations were carried out after treatment with botulinum toxin-A. In affected hands, significantly higher mean standard deviations of timing parameters were seen compared with healthy reference hands. After treatment with botulinum toxin-A, significant improvements in performance parameters were monitored by Scale Analysis. Mean standard deviations of inter-onset intervals correlated with ADDS scores. We conclude that Scale Analysis is an effective and precise tool for quantification of focal dystonia in pianists and provides fine resolution. It is independent of rating methods and allows reliable follow-up examinations during treatment.