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MHH neurologist is researching the causes and looking for possible treatments for the neurological movement disorder in professional pianists.
Anyone who wants to make music their profession must, above all, be willing to practice. Even before they start their music studies, children and young people who aspire to such a career spend an average of 10,000 hours on their instrument. And even as a professional, at least three to four hours of practice time is mandatory. But that can leave its mark: the so-called musician's dystonia. This neurological movement disorder can lead, for example, to cramping of the finger muscles and to a loss of coordination and control when playing the instrument. It affects about one to two per cent of professional musicians. However, amateurs can also lose the fine motor skills that are essential for playing their instrument. The causes of the disease are not yet understood, but in addition to predisposition and practice behaviour, the neural network in the brain plays an important role.
Dr Johanna Doll-Lee and her research team are now seeking to shed light on the issue. The assistant doctor at the Department of Neurology with Clinical Neurology at the Hannover Medical School (MHH) is conducting research into movement disorders and is investigating the brain activity of professional musicians affected by dystonia as part of her project ‘Movement Observation and Imagination in Musicians’ Dystonia’. Her long-term goal is to be able to treat the problem at its root cause in a sustainable way. The German Research Foundation is funding the project with around 270,000 euros and is enabling the doctor to take two years off from the clinic to devote herself fully to her scientific work.
Severe strain caused by rapid and repetitive movement
Robert Schumann was one of the first musicians to learn that the disease can end a professional career. As a young concert pianist, he practised so intensively that the middle finger of his right hand began to bend involuntarily while playing the piano, preventing him from playing scales and fast sequences on the piano. Schumann had to change careers, became a composer and even wrote piano pieces that did not use his right middle finger. ‘In particular, repetitive and fast movements that have to be very precise in terms of space and time can pose a risk for the development of musician's dystonia,’ explains Dr Doll-Lee, who is a concert pianist herself. ’That's why professional violin and piano players, for example, are particularly often affected.’
Botox treatment alleviates the symptoms
The symptoms are treated with the bacterial toxin botulinum toxin A, better known as Botox. The active agent is administered by injection into the affected muscles, where it reduces the over-activation and thus the involuntary cramping of muscles during playing. However, the treatment is challenging, since not only the individually correct dose must be determined for each case, but also the actual affected muscle strand must be found using ultrasound. The extensive expertise required for this is available at only a few locations worldwide, such as the special outpatient clinic of the Institute for Music Physiology and Musician's Medicine at the Hanover University of Music, Drama and Media, a cooperation partner of the project. ‘The institute is the oldest for musician-specific illnesses and has been offering an international point of contact for decades for musicians from all over the world with playing-related complaints,’ says Dr. Doll-Lee. ’Thanks to this unique collaboration, I can recruit a sufficient number of musicians with musician's dystonia across city and national borders, so that my studies are meaningful.’
Imagination and mirror neurons
For her study, Dr Doll-Lee is focusing on right-handed pianists with and without musician's dystonia. In preliminary imaging studies, the neurologist has determined that task-specific dystonia, such as musician's dystonia, is ultimately a neuronal network disease. It affects the nerve cells of the cerebral cortex, the cerebellum and the basal ganglia – a collection of nerve cells deep in the brain that coordinate fluid muscle movement and changes in posture.
To gain a better understanding of the disease, she now wants to examine what happens in the brains of those affected while they play rapid scales – a problematic task for those with dystonia. Since playing on a grand piano is not possible during an MRI scan, the neurologist draws on the musicians' imagination and their mirror neurons. These are nerve cells that trigger the same activity pattern in the brain when merely observing an action as if the process were being carried out by the motor itself.
Presumably different activity patterns
In an MRI scanner, patients watch a video of a hand playing rapid scales on the piano multiple times. In the second part of the task, the participants are asked to imagine playing the same scale themselves. In both cases, their brain processes what it has seen and then the mere imagination as if they had actually played the scale themselves. ‘We suspect that there are differences in brain activity in comparison to healthy control subjects,’ says the neurologist. If the mechanisms of the disease are better understood, the neurologist hopes that a therapy can be found that actually addresses the causes. ’If we know which brain region is, so to speak, in the way, we could, for example, try to stimulate it with magnetic fields and electricity to release the blockage.’
SERVICE
For further information, please contact Dr Johanna Doll-Lee, doll-lee.johanna@mh-hannover.de.
Doctor and professional pianist: Dr. Johanna Doll-Lee is researching the neurological causes of musi ...
Copyright: Karin Kaiser/MHH
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Doctor and professional pianist: Dr. Johanna Doll-Lee is researching the neurological causes of musi ...
Copyright: Karin Kaiser/MHH
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