Objective: To demonstrate the efficacy and safety of incobotulinumtoxinA  and the importance of simultaneous US and EMG guide in targeting single finger muscles in musician’s dystonia

Background: Musician’s dystonia is a task specific  movement disorder which  presents as loss of voluntary motor control in extensively trained movements. Botulinum toxin (BoNT) injected in dystonic muscles  is considered an efficacious treatment (1);  US guide has recently been recognize to be  useful in the muscle targeting (2).

Methods: musicians affected by upper limb focal dystonia,  afferent in the last 3 years to the “Sol Diesis clinic” were clinically analyzed  and video recorde by a multispecialist  skilled team during musical performance and  treated with a EMG-US guided incobotulinumtoxinA injections in the dystonic muscles. Patients were asked to estimate their average playing ability before and after each toxin treatment using a VAS Performance Scale.  

Data were statistically analyzed using  Student t test. 

Results: 15 musicians (mean age 43,9± 14,54; 14 males and 1 female), 10 professional player (3 violin, 4 guitar,1 electric guitar, 1 director, 1 accordion) and 5 professional teachers (4 guitar, 1 flute) were treated.  No major side effect were reported  (only one case of overshoot weakness after injection); inter-injection intervals were variable;  in one case  boost injections  were performed.

Significant statistically improvement of the  VAS Performance  Scale after each treatment (22 treatments)  was recorded (p< .05) with a mean value of  VAS 4.74 ±1.6 pre and 6.63±2.16 post.

10 patients received only one treatment .3  musicians have  3 years follow up with repeated efficacious injections; 8 patients perform regular professional orchestral and soloist activity. Median efficacious dosage on  single finger flexors muscle, injected in 12 pts (Flexor digitorum superficialis/profundus) was 11 ± 7.4 U (dilution 100 U in 1 ml). 7 patients associated motor learning techniques with BoNT injections.

Conclusions: IncobotulinumtoxinA can be considered  an efficacious  treatment  in  musician’s upper limb  dystonia in particular involving finger flexors muscles, also at low dosage, with limited  side effects.  EMG-US guide is very useful in the diagnostic targeting process and to determine an efficacious dosage.

References: 1) Schuele  S et al. Botulinum toxin injections in the treatment of musician’s dystonia.Neurology 2005 .

2) Walter U1, Dressler D Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother. 2014 Aug;14(8):923-36. doi: 10.1586/14737175.2014.936387. Epub 2014 Jul 21.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/emg-us-guided-incobotulinum-toxina-treatment-of-a-cohort-of-musicians-affected-by-upper-limb-focal-dystonia/