Loss of muscle control or dystonia (when muscles contract uncontrollably) would be disconcerting to anyone, but it can be a career-ending disorder for trained musicians.
Musician's dystonia is characterized by excessive muscle contractions that disrupt the fine motor control that musicians rely on to perform. Treating patients with this disorder is one part of the Music and Movement Disorders Initiative created by Christine Kim, MD, assistant professor of neurology in the Division of Movement Disorders at Columbia University Vagelos College of Physicians and Surgeons and a neurologist at NewYork-Presbyterian.
Before becoming a neurologist, Kim completed two degrees at the Eastman School of Music in violin performance. Her goal was to play full time in an orchestra. She still performs professionally on occasion, but her career track changed when she developed an interest in neuroscience and medicine. She completed medical school, neurology residency, and fellowship training in movement disorders at Columbia, where she became particularly interested in the intersection of music and movement disorders.
"Professional musicians have a singular identity. They start training early and decide on a career path at a relatively young age," Kim says. "It requires many hours of practice and achieving that high level is rewarding, but when disrupted, it's devastating.
Musicians with dystonia can be in their 20s and 30s and just starting their musical careers. "The majority have to leave music performance because they are unable to play with the precision required of a professional," Kim says.
Violinists more commonly develop dystonia in the fingers of the left hand. Those who perform with brass and wind instruments sometimes develop involuntary, distorted movements of their mouths.
Dystonia comes from aberrant brain activity that likely develops in part from over-training in repetitive motions. Violinists more commonly develop dystonia in the fingers of the left hand, which do more repetitive work through the years; it's less common in the right (bow) arm. Those who perform with brass and wind instruments sometimes develop involuntary, distorted movements of their mouths.
The primary treatment is the injection of botulinum toxin into the affected muscles, which mildly weakens them and reduces the frequency of contractions. This can be effective in improving dystonia but can be limited by functional weakness of those muscles.
To develop better therapies, Kim plans to learn what happens in the brain with musician's dystonia. A functional MRI study is just getting underway, in which Kim will characterize central brain changes.
"We are looking to immediately improve clinical care through translational research," she says. "By identifying and researching gaps in current treatments, we can return with new approaches that directly improve clinical care."
Music as medicine
Kim also uses music as medicine for people with other movement disorders including Parkinson's, atypical parkinsonism, tremor, ataxia, chorea, and other types of dystonia.
The program is also starting to work with patients with gait disorders. "Patients tell us they move better when they listen to music while walking, for example. They recover their fluidity better," she says.
"Patients tell us they move better when they listen to music while walking...they recover their fluidity better."
"It's like a metronome. We will be looking at different tempos, the fluidity and other parameters of the walk, and delivering rhythmic-based intervention to help patients."
Kim credits much of the music program's success to local collaborators: A robust, interactive concert series is already up and running through Project: Music Heals Us, a nonprofit that provides education, engagement, and healing through virtual and live musical performances and interactive programming. The Manhattan School of Music Community Partnership connects with New Yorkers by bringing music to students, seniors, and hospice patients.
"My main goal with the Music and Movement Disorders Initiative at Columbia is to build a program of interactive, music-based interventions to improve symptoms and quality of life in patients with movement disorders and leverage the overlap between music and human movement," Kim says.
References
Patients interested in evaluation can contact the Columbia Movement Disorders Division.
