Epidemiology and treatment of 23 musicians with task specific tremor.

André Lee,Eckart Altenmüller,Shinichi Furuya

doi:10.1186/2054-7072-1-5

André Lee, Eckart Altenmüller + Show 1 more

Open Access

https://doi.org/10.1186/2054-7072-1-5

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Abstract

BackgroundTask specific tremors in musicians have been mainly described as primary bowing tremor in string instrumentalists in relatively small sample sizes. Our aim was to describe epidemiology, risk factors, phenomenology and treatment options of this disorder in 23 musicians of different instruments.MethodsWe included 23 professional musicians (4 female, 19 male; mean age 51.5 ± 11.4 years) with a TSTM. During anamnesis, clinical examination, by mail or via telephone patients were asked for epidemiological, phenomenological information, risk factors and treatments. We then compared our findings to primary writing tremor, the most common task specific tremor.ResultsAge at onset of the TST was 44.6 ± 13.6 years and tremor appeared 35.1 ± 13.5 years after beginning to play the instrument. The majority of patients were string instrumentalists, followed by woodwind instrumentalists. Other instrumentalists were a guitarist, pianist and percussionist respectively. In contrast to primary writing tremor, we also found proximal muscles of the upper extremity involved in tremor. A positive family history was found in Prior trauma was more common than in primary writing tremor. Treatment with a positive effect on tremor were in order of efficacy: Botulinumtoxin, Primidone, Propranolol, Trihexyphenidyl. No patient had undergone deep brain stimulation.ConclusionTask specific tremor in musicians is a heterogeneous disorder with a male gender predominance that shares many commonalities with PWT. The onset age as well as the time between starting to play the instrument and tremor onset has a wide range. Because previous trauma and overuse appear to be risk factors, preventive measures against playing related injuries are necessary. There appears to be a genetic predisposition for TST. No single beneficial medication exists and treatment of patients remains highly individual. It should be discussed, whether deep brain stimulation should be offered not only to patients that do not respond to any other medication but early in the course of the disease.Electronic supplementary materialThe online version of this article (doi:10.1186/2054-7072-1-5) contains supplementary material, which is available to authorized users.

Highlights

Task specific tremors in musicians have been mainly described as primary bowing tremor in string instrumentalists in relatively small sample sizes
One patient had a dystonia before onset of Task specific tremor in musicians (TSTM), at clinical examination no dystonic posturing was visible, and only tremor was discernible
The main differences to primary writing tremor (PWT) are firstly that we found an involvement of proximal muscles, which to our knowledge has not been reported in PWT

Summary

Introduction

Task specific tremors in musicians have been mainly described as primary bowing tremor in string instrumentalists in relatively small sample sizes. Task specific tremor in musicians (TSTM) is a highly disabling disorder that occurs only or mainly while playing the instrument and has primarily been described in string instrumentalists as primary bowing tremor (PBT) [1,2,3]. By mail or via telephone the following information were asked for: Age, age when starting to play the instrument and age at onset of tremor; time between starting to play the instrument and tremor onset; previous trauma; whether the professional position as before tremor was still upheld (e.g. an orchestra musician was still playing in an orchestra); responsiveness to alcohol; family history for movement disorders.

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