Focal dystonia: current theories

Dystonia is a syndrome characterised by abnormal involuntary sustained muscle contractions that often result in twisted and abnormal positions. Focal dystonia affects only a single body part with symptoms varying from permanent (e.g., torticollis) to task-specific (e.g., musician's cramp). The exact causes of focal dystonia have yet to be determined. Possible causative factors have been identified at all levels along the sensorimotor pathway, including anatomical constraints of the hand (musicians), abnormal co-contractions of the muscles due to reciprocal inhibition in the spinal cord, subcortical and cortical remapping, deficiencies in sensorimotor integration and perceptual deficits. A review of the current literature on these topics is provided with a special focus on musicians with focal dystonia. Also reviewed are current treatments of focal dystonia in musicians. On the basis of the currently available evidence, certain risk factors are identified for the development of task-specific focal dystonia, including number of practice hours, personality, genetic predisposition, performance factors and sensory effects. In addition, it is highlighted that dystonic movements occur predominantly in the context of perceptual-motor tasks involving emotions. When emotional and motor traces have become associated, they are difficult to change; it is suggested that this mechanism plays an important role in the preservation of dystonic symptoms.