Centro de Trastornos del Movimiento, Universidad de Santiago de Chile (CETRAM-USACH), Hospital Geriátrico de Santiago de Chile, Santiago de Chile, Chile.
Neurologia. 2011 Jan-Feb;26(1):45-52. doi: 10.1016/j.nrl.2010.09.019. Epub 2010 Nov 18.
A special group of focal dystonia is that known as occupational, which include dystonic disorders triggered by repetitive motor activity, closely associated with the professional activity of a specific task that the affected person performs. In this sense, musicians are a population particularly vulnerable to this disorder, which is presented during the execution of highly trained movements.
This article reviews the pathophysiology of focal dystonia and its therapeutic implications.
The pathophysiological basis of focal dystonia in the musician is still not well established. However, due to the contribution of neurophysiological studies and functional neuroimaging, there is growing evidence of anomalies in the processing of sensory information, sensory-motor integration, cortical and subcortical inhibitory processes, which underline this disease. Clinically, it is characterised by the appearance of involuntary muscle contractions, and is associated with loss of motor control while practicing music. It is a gradual appearance and sometimes there may be a history of musculoskeletal injuries or non-physiological postures preceding the appearance of the symptoms. The neurological examination is usually normal, although subtle dystonic postures can develop spontaneously or with movements that involve the affected segments. The dystonia remains focal and is not generalised.
Treatment is based on using multiple strategies for the management of the dystonia, with variable results. Although a specific therapy has not been defined, there are general principles that are combined in each situation looking for results. This includes, among others, pharmacological interventions, management with botulinum toxin, and sensory re-training techniques.
一种特殊类型的局灶性肌张力障碍是职业性的，包括由重复运动活动引发的运动障碍，与受影响者执行的特定任务的职业活动密切相关。在这个意义上，音乐家是特别容易受到这种障碍影响的人群，这种障碍在执行高度训练的动作时表现出来。
本文综述了局灶性肌张力障碍的病理生理学及其治疗意义。
音乐家局灶性肌张力障碍的病理生理学基础尚未得到很好的确定。然而，由于神经生理学研究和功能神经影像学的贡献，越来越多的证据表明感觉信息处理、感觉运动整合、皮质和皮质下抑制过程的异常，这突显了这种疾病。临床上，它的特征是出现不随意的肌肉收缩，并且在演奏音乐时与运动控制的丧失有关。它是逐渐出现的，有时可能有肌肉骨骼损伤或非生理姿势的病史，然后出现症状。神经系统检查通常正常，尽管在涉及受影响部位的运动时，可能会自发或出现轻微的肌张力障碍姿势。肌张力障碍仍然是局灶性的，而不是全身性的。
治疗基于使用多种策略来管理肌张力障碍，结果各不相同。虽然尚未确定特定的治疗方法，但有一些一般原则，在每种情况下结合起来寻找结果。这包括药物干预、肉毒杆菌毒素管理和感觉再训练技术等。
