Musician's Dystonia Somehow Corrupts the Sensory Motor Symptoms Programs Associated with Playing the Instrument

Total Page:16

File Type:pdf, Size:1020Kb

Musician's Dystonia Somehow Corrupts the Sensory Motor Symptoms Programs Associated with Playing the Instrument Musician’s Dystonia Professional musicians are susceptible may develop symptoms in either hand. to a number of occupational conditions , Woodwind players may develop symp - including task-specific focal dystonia . tom s in the hands, face, or mouth. Dystonia is a neurological disorder Brass players are usually affected in characterized by involuntary muscle the corners of the mouth and jaw. contractions and postures. There is typically no pain associated The term focal indicates that the with musician’s dystonia. dystonia affects a single, specific area of the body. The term task-specific Because musician’s dystonia is a indicates that the symptoms only occur neurological disorder, the aim of when the individual is completing treatment is to help the nervous a particular task, such as playing a system relearn the ability to complete musical instrument. specific movement tasks without triggering dystonia. Experts estimate that 1-2% of professional musicians are affected The origins of musician’s dystonia by dystonia, but there are likely large are being researched by scientists numbers of musicians living with around the world. As a person symptoms who remain unidentified. develops and learns movement tasks, Almost all individuals with musician’s these movements are stored in the dystonia are classically trained, and brain as sensory motor programs. most are male. Musician's dystonia somehow corrupts the sensory motor Symptoms programs associated with playing the instrument. The first signs of musician’s dystonia are lapses in the usually instinctive ability to perform on the instrument. Although there is no cure for musician’s dystonia at this Musicians may perceive the early symptoms of dystonia time, several treatment options exist. as a result of faulty technique or insufficient preparation. Embouchure Dystonia Musician’s dystonia is triggered by playing the instrument Embouchure dystonia is a type of dystonia that affects and does not typically affect other activities. The top brass and woodwind players. Embouchure dystonia three musical instruments associated with musician’s targets muscles in the mouth, face, jaw, and tongue. dystonia are piano, guitar, and brass instruments. The involuntary, abnormal movements associated with Pianists typically develop symptoms in the right hand, embouchure dystonia are often very subtle and occur often affecting the fingers. String players usually experience only when the musician is playing, buzzing into the symptoms in the left hand. Guitarists and percussionists mouthpiece, or forming the embouchure. Symptoms of embouchure dystonia may include air leaks Musician’s hand dystonia is highly task specific, and at the corners of the mouth, sometimes accompanied may have a prominent sensory component. For example, by a tremor, and involuntary contractions of the muscles a pianist may experience symptoms with playing on in the face. ivory keys but not while playing on plastic. Treatment may include rehabilitative methods that Treatment may include rehabilitative methods that attempt to retrain the nervous system to perform on attempt to retrain the nervous system to perform on the instrument without triggering symptoms, oral the instrument without triggering symptoms, oral medications, and botulinum neurotoxin injections medications, and botulinum neurotoxin injections administered by an experienced physician. administered by an experienced physician. A neurologist who specializes in movement disorders A neurologist who specializes in movement disorders is typically the most appropriate physician to diagnosis is typically the most appropriate physician to diagnosis and treat embouchure dystonia. and treat hand dystonia. Hand Dystonia Support Focal hand and limb dystonia is characterized by Musicians With Dystonia (MWD) was founded in involuntary, abnormal movements in the hands and/or 2000 by Glen Estrin, a former professional French horn fingers. Hand dystonia is seen in pianists, string players, player diagnosed with embouchure dystonia, and Steven guitarists, percussionists, and woodwind players. Frucht, MD in partnership with the Dystonia Medical Research Foundation. Symptoms of hand dystonia may include subtle loss of control in fast passages, lack of precision, curling of the MWD established a network of health care practitioners fingers, fingers “sticking” to keys, involuntary flexion of knowledgeable about the disorder and an informal support the thumb in strings, and tremor. network of fellow affected musicians. MORE INFORMATION: One East Wacker Drive, Suite 1730 • Chicago, Illinois 60601-1905 Toll free: 800-377-DYST (3978) • Phone: 312-755-0198 Email: [email protected] Web: http://www.dystonia-foundation.org/musicians Find the DMRF on Facebook, Twitter, and YouTube. © Dystonia Medical Research Foundation 2016.
Recommended publications
  • Applied Anatomy in Music: Body Mapping for Trumpeters
    UNLV Theses, Dissertations, Professional Papers, and Capstones May 2016 Applied Anatomy in Music: Body Mapping for Trumpeters Micah Holt University of Nevada, Las Vegas Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Music Commons Repository Citation Holt, Micah, "Applied Anatomy in Music: Body Mapping for Trumpeters" (2016). UNLV Theses, Dissertations, Professional Papers, and Capstones. 2682. http://dx.doi.org/10.34917/9112082 This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Theses, Dissertations, Professional Papers, and Capstones by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. APPLIED ANATOMY IN MUSIC: BODY MAPPING FOR TRUMPETERS By Micah N. Holt Bachelor of Arts--Music University of Northern Colorado 2010 Master of Music University of Louisville 2012 A doctoral project submitted in partial fulfillment of the requirements for the Doctor of Musical Arts School of Music College of Fine Arts The Graduate College University of Nevada, Las Vegas May 2016 Dissertation Approval The Graduate College The University of Nevada, Las Vegas April 24, 2016 This dissertation prepared by Micah N.
    [Show full text]
  • Joshua Bynum, Trombone Anatoly Sheludyakov, Piano Joshua Bynum
    Presents a Presents a Faculty Recital Faculty Recital Joshua Bynum, trombone Joshua Bynum, trombone Anatoly Sheludyakov, piano Anatoly Sheludyakov, piano October 16, 2019 6:00 pm, Edge Recital Hall October 16, 2019 6:00 pm, Edge Recital Hall Radiant Spheres David Biedenbender Radiant Spheres David Biedenbender I. Fluttering, Fast, Precise (b. 1984) I. Fluttering, Fast, Precise (b. 1984) II. for me, time moves both more slowly and more quickly II. for me, time moves both more slowly and more quickly III. Radiant Spheres III. Radiant Spheres Someone to Watch Over Me George Gershwin Someone to Watch Over Me George Gershwin (1898-1937) (1898-1937) Arr. Joseph Turrin Arr. Joseph Turrin Simple Song Leonard Bernstein Simple Song Leonard Bernstein (1918-1990) (1918-1990) Zion’s Walls Aaron Copland Zion’s Walls Aaron Copland (1900-1990) (1900-1990) -intermission- -intermission- I Was Like Wow! JacobTV I Was Like Wow! JacobTV (b. 1951) (b. 1951) Red Sky Anthony Barfield Red Sky Anthony Barfield (b. 1981) (b. 1981) **Out of respect for the performer, please silence all electronic devices throughout the performance. **Out of respect for the performer, please silence all electronic devices throughout the performance. Thank you for your cooperation. Thank you for your cooperation. ** For information on upcoming concerts, please see our website: music.uga.edu. Join ** For information on upcoming concerts, please see our website: music.uga.edu. Join our mailing list to receive information on all concerts and our mailing list to receive information on all concerts and recitals, music.uga.edu/enewsletter recitals, music.uga.edu/enewsletter Dr. Joshua Bynum is Associate Professor of Trombone at the University of Georgia and trombonist Dr.
    [Show full text]
  • Recommended Solos and Ensembles Tenor Trombone Solos Sång Till
    Recommended Solos and Ensembles Tenor Trombone Solos Sång till Lotta, Jan Sandström. Edition Tarrodi: Stockholm, Sweden, 1991. Trombone and piano. Requires modest range (F – g flat1), well-developed lyricism, and musicianship. There are two versions of this piece, this and another that is scored a minor third higher. Written dynamics are minimal. Although phrases and slurs are not indicated, it is a SONG…encourage legato tonguing! Stephan Schulz, bass trombonist of the Berlin Philharmonic, gives a great performance of this work on YouTube - http://www.youtube.com/watch?v=Mn8569oTBg8. A Winter’s Night, Kevin McKee, 2011. Available from the composer, www.kevinmckeemusic.com. Trombone and piano. Explores the relative minor of three keys, easy rhythms, keys, range (A – g1, ossia to b flat1). There is a fine recording of this work on his web site. Trombone Sonata, Gordon Jacob. Emerson Edition: Yorkshire, England, 1979. Trombone and piano. There are no real difficult rhythms or technical considerations in this work, which lasts about 7 minutes. There is tenor clef used throughout the second movement, and it switches between bass and tenor in the last movement. Range is F – b flat1. Recorded by Dr. Ron Babcock on his CD Trombone Treasures, and available at Hickey’s Music, www.hickeys.com. Divertimento, Edward Gregson. Chappell Music: London, 1968. Trombone and piano. Three movements, range is modest (G-g#1, ossia a1), bass clef throughout. Some mixed meter. Requires a mute, glissandi, and ad. lib. flutter tonguing. Recorded by Brett Baker on his CD The World of Trombone, volume 1, and can be purchased at http://www.brettbaker.co.uk/downloads/product=download-world-of-the- trombone-volume-1-brett-baker.
    [Show full text]
  • Vocal Cord Dysfunction in Amyotrophic Lateral Sclerosis Four Cases and a Review of the Literature
    NEUROLOGICAL REVIEW SECTION EDITOR: DAVID E. PLEASURE, MD Vocal Cord Dysfunction in Amyotrophic Lateral Sclerosis Four Cases and a Review of the Literature Maaike M. van der Graaff, MD; Wilko Grolman, MD, PhD; Erik J. Westermann, MD; Hans C. Boogaardt; Hans Koelman, MD, PhD; Anneke J. van der Kooi, MD, PhD; Marina A. Tijssen, MD, PhD; Marianne de Visser, MD, PhD e describe 4 patients with amyotrophic lateral sclerosis (ALS) and glottic nar- rowing due to vocal cord dysfunction, and review the literature found using the following search terms: amyotrophic lateral sclerosis, motor neuron disease, stri- dor, laryngospasm, vocal cord abductor paresis, and hoarseness. Neurological Wliterature rarely reports vocal cord dysfunction in ALS, in contrast to otolaryngology literature (4%- 30% of patients with ALS). Both infranuclear and supranuclear mechanisms may play a role. Vocal cord dysfunction can occur at any stage of disease and may account for sudden death in ALS. Treat- ment of severe cases includes acute airway management and tracheotomy. Arch Neurol. 2009;66(11):1329-1333 Amyotrophic lateral sclerosis (ALS) is a neu- (VCAP), it is potentially life threatening, as rodegenerative disease characterized by fea- a predominance of vocal cord adduction re- tures indicative of both upper and lower sults in glottic narrowing or even occlu- motor neuron degeneration. Initial manifes- sion. Assessment by an otolaryngologist is tations usually include weakness in the bul- then of the highest priority. Stridor is a well- bar region or weakness of the limbs. Progres- known symptom in multiple system atro- sive weakness leads to increasing disability phy and may also incidentally occur in other and respiratory insufficiency, resulting in neurodegenerative diseases.8-10 Laryngo- death.
    [Show full text]
  • Working List of Repertoire for Tenor Trombone Solo and Bass Trombone Solo by People of Color/People of the Global Majority (POC/PGM) and Women Composers
    Working List of Repertoire for tenor trombone solo and bass trombone solo by People of Color/People of the Global Majority (POC/PGM) and Women Composers Working list v.2.4 ~ May 30, 2021 Prepared by Douglas Yeo, Guest Lecturer of Trombone Wheaton College Conservatory of Music Armerding Center for Music and the Arts www.wheaton.edu/conservatory 520 E. Kenilworth Avenue Wheaton, IL 60187 Email: [email protected] www.wheaton.edu/academics/faculty/douglas-yeo Works by People of Color/People of the Global Majority (POC/PGM) Composers: Tenor trombone • Amis, Kenneth Preludes 1–5 (with piano) www.kennethamis.com • Barfield, Anthony Meditations of Sound and Light (with piano) Red Sky (with piano/band) Soliloquy (with trombone quartet) www.anthonybarfield.com 1 • Baker, David Concert Piece (with string orchestra) - Lauren Keiser Publishing • Chavez, Carlos Concerto (with orchestra) - G. Schirmer • Coleridge-Taylor, Samuel (arr. Ralph Sauer) Gypsy Song & Dance (with piano) www.cherryclassics.com • DaCosta, Noel Four Preludes (with piano) Street Calls (unaccompanied) • Davis, Nathaniel Cleophas (arr. Aaron Hettinga) Oh Slip It Man (with piano) Mr. Trombonology (with piano) Miss Trombonism (with piano) Master Trombone (with piano) Trombone Francais (with piano) www.cherryclassics.com • John Duncan Concerto (with orchestra) Divertimento (with string quartet) Three Proclamations (with string quartet) library.umkc.edu/archival-collections/duncan • Hailstork, Adolphus Cunningham John Henry’s Big (Man vs. Machine) (with piano) - Theodore Presser • Hong, Sungji Feromenis pnois (unaccompanied) • Lam, Bun-Ching Three Easy Pieces (with electronics) • Lastres, Doris Magaly Ruiz Cuasi Danzón (with piano) Tres Piezas (with piano) • Ma, Youdao Fantasia on a Theme of Yada Meyrien (with piano/orchestra) - Jinan University Press (ISBN 9787566829207) • McCeary, Richard Deming Jr.
    [Show full text]
  • Diagnosis and Treatment of Multiple System Atrophy: an Update
    ReviewSection Article Diagnosis and Treatment of Multiple System Atrophy: an Update Abstract the common parkinsonian variant (MSA-P) from PD. In his review provides an update on the diagnosis a clinicopathologic study1, primary neurologists (who Tand therapy of multiple system atrophy (MSA), a followed up the patients clinically) identified only 25% of sporadic neurodegenerative disorder characterised MSA patients at the first visit (42 months after disease clinically by any combination of parkinsonian, auto- onset) and even at their last neurological follow-up (74 nomic, cerebellar or pyramidal symptoms and signs months after disease onset), half of the patients were still and pathologically by cell loss, gliosis and glial cyto- misdiagnosed with the correct diagnosis in the other half plasmic inclusions in several brain and spinal cord being established on average 4 years after disease onset. structures. The term MSA was introduced in 1969 Mean rater sensitivity for movement disorder specialists although prior to this cases of MSA were reported was higher but still suboptimal at the first (56%) and last Gregor Wenning obtained an MD at the under the rubrics of striatonigral degeneration, olivo- (69%) visit. In 1998 an International Consensus University of Münster pontocerebellar atrophy, Shy-Drager syndrome and Conference promoted by the American Academy of (Germany) in 1991 and idiopathic orthostatic hypotension. In the late Neurology was convened to develop new and optimised a PhD at the University nineties, |-synuclein immunostaining was recognised criteria for a clinical diagnosis of MSA2, which are now of London in 1996. He received his neurology as the most sensitive marker of inclusion pathology in widely used by neurologists.
    [Show full text]
  • Portable Digital Musical Instruments 2009 — 2010
    PORTABLE DIGITAL MUSICAL INSTRUMENTS 2009 — 2010 music.yamaha.com/homekeyboard For details please contact: This document is printed with soy ink. Printed in Japan How far do you want What kind of music What are your Got rhythm? to go with your music? do you want to play? creative inclinations? Recommended Recommended Recommended Recommended Tyros3 PSR-OR700 NP-30 PSR-E323 EZ-200 DD-65 PSR-S910 PSR-S550B YPG series PSR-E223 PSR-S710 PSR-E413 Pages 4-7 Pages 8-11 Pages 12-13 Page 14 The sky's the limit. Our Digital Workstations are jam-packed If the piano is your thing, Yamaha has a range of compact We've got Digital Keyboards of all types to help players of every If drums and percussion are your strong forte, our Digital with advanced features, exceptionally realistic sounds and piano-oriented instruments that have amazingly realistic stripe achieve their full potential. Whether you're just starting Percussion unit gives you exceptionally dynamic and expressive performance functions that give you the power sound and wonderfully expressive playability–just like having out or are an experienced expert, our instrument lineup realistic sounds, letting you pound out your own beats–in to create, arrange and perform in any style or situation. a real piano in your house, with a fraction of the space. provides just what you need to get your creative juices flowing. live performance, in rehearsal or in recording. 2 3 Yamaha’s Premier Music Workstation – Unsurpassed Quality, Features and Performance Ultimate Realism Limitless Creative Potential Interactive
    [Show full text]
  • Clinical Manifestation of Juvenile and Pediatric HD Patients: a Retrospective Case Series
    brain sciences Article Clinical Manifestation of Juvenile and Pediatric HD Patients: A Retrospective Case Series 1, , 2, 2 1 Jannis Achenbach * y, Charlotte Thiels y, Thomas Lücke and Carsten Saft 1 Department of Neurology, Huntington Centre North Rhine-Westphalia, St. Josef-Hospital Bochum, Ruhr-University Bochum, 44791 Bochum, Germany; [email protected] 2 Department of Neuropaediatrics and Social Paediatrics, University Children’s Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; [email protected] (C.T.); [email protected] (T.L.) * Correspondence: [email protected] These two authors contribute to this paper equally. y Received: 30 April 2020; Accepted: 1 June 2020; Published: 3 June 2020 Abstract: Background: Studies on the clinical manifestation and course of disease in children suffering from Huntington’s disease (HD) are rare. Case reports of juvenile HD (onset 20 years) describe ≤ heterogeneous motoric and non-motoric symptoms, often accompanied with a delay in diagnosis. We aimed to describe this rare group of patients, especially with regard to socio-medical aspects and individual or common treatment strategies. In addition, we differentiated between juvenile and the recently defined pediatric HD population (onset < 18 years). Methods: Out of 2593 individual HD patients treated within the last 25 years in the Huntington Centre, North Rhine-Westphalia (NRW), 32 subjects were analyzed with an early onset younger than 21 years (1.23%, juvenile) and 18 of them younger than 18 years of age (0.69%, pediatric). Results: Beside a high degree of school problems, irritability or aggressive behavior (62.5% of pediatric and 31.2% of juvenile cases), serious problems concerning the social and family background were reported in 25% of the pediatric cohort.
    [Show full text]
  • The Lion's Roar
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ The Lion’s Roar A Thorne Student Publication Winter 2019 Still Free Elf Day Pg 3, Mania Album Review, Pg 3, Winter Concert Pg 4, The Arts Op Ed, Pg 4, Art Pg 5, Poetry Pg 6, ​ ​ Investigative Spotlight-Social Media Pg 8 Chinchillas Thorne Giving Back Kara Gallagher By: Kristen Gallagher Fortnite Allegedly Dying, ​ Streamer Protests Notion By Liam Perez Since its initial release on September 26, 2017, the We all know the holidays are a great immensely popular online game time of year. Opening our presents known as Fortnite: Battle Royale on Christmas morning with beaming ​ has captured the hearts, minds, smiles is always a joy, but what about those who aren’t as fortunate and wallets of over 200 million As you may know, the 7th-grade as us? players ​ science classes have adorable, soft I am a member of Thorne’s peer worldwide(pcgamesn.com, 2018). chinchillas, but do you really know leaders, and we were invited to help However, speculation that Fortnite: Battle Royale’s time in anything about those fuzzy, out with a holiday toy drive that ​ eye-watering creatures? Well, if you benefits Middletown residents. When the public eye is drawing to a don’t, you should definitely read this I heard of this volunteer close, or that it is ‘dead.’ This article. I will write about chinchilla opportunity, I was interested right leads to the questions of “is this fun facts, and caring for a pet away. Approximately twenty other true?” and “if it is, what’s next?”, chinchilla. Thorne students participated.
    [Show full text]
  • FRENCH CONNECTIONS with Avery Gagliano, Piano
    FRENCH CONNECTIONS with Avery Gagliano, piano February 13, 2021 | 7:30 PM Welcome to OMP's Virtual Concert Hall! Bonjour et bienvenue! Thank you to our loyal donors and season subscribers for your continued support, and a warm welcome to those who are joining us in our "Virtual Concert Hall" for the first time. Your contributions have made it possible for OMP to present our third virtual chamber orchestra performance in HD audio and video! We hope you enjoy this programme musical français featuring First Prize and Best Concerto Prize winner of the 2020 10th National Chopin Piano Competition Avery Gagliano! THANK YOU TO THESE GENEROUS GRANTING ORGANIZATIONS: Get the PremiumExperience! Level A Subscription Seat Access to Virtual Premium Special Concerts and additional OMP content or concerts. Receive "Kelly's Recommendation" in headphones: Bose® SoundLink around-ear headphones II with contactless shipping Select a personally autographed CD or DVD of "A Virtual Recital", featuring 2015 Young Soloist Competition Winner John Fawcett, violin and Kelly Kuo, piano. Complimentary, contactless wine delivery upon virtual reception advanced reservation Current 2020-21 Subscribers can use the amount of their tickets as a credit toward their purchase of an OMP Premium Experience Package! Give the gift of with OMP and Bose at oregonmomzaurstipclayers.org/tickets Orchestra Kelly Kuo, Artistic Director & Conductor VIOLIN Jenny Estrin, acting concertmaster Yvonne Hsueh, principal 2nd violin Stephen Chong Della Davies Sponsored by Nancy & Brian Davies Julia Frantz Sponsored by James & Paula Salerno Nathan Lowman Claudia Miller Sponsored by Jeffrey Morey & Gail Harris Sophie Therrell Sponsored by W. Mark & Anne Dean Alwyn Wright* VIOLA Arnaud Ghillebaert principal viola Lauren Elledge Kimberly Uwate* CELLO Dale Bradley acting principal cello Sponsored by Larissa Ennis & Lindsay Braun Eric Alterman Noah Seitz BASS Nicholas Burton, principal bass HARPSICHORD/PIANO Thank you to our additional musician sponsors: John Jantzi, Theodore W.
    [Show full text]
  • Natural Trumpet Music and the Modern Performer A
    NATURAL TRUMPET MUSIC AND THE MODERN PERFORMER A Thesis Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Master of Music Laura Bloss December, 2012 NATURAL TRUMPET MUSIC AND THE MODERN PERFORMER Laura Bloss Thesis Approved: Accepted: _________________________ _________________________ Advisor Dean of the College Dr. Brooks Toliver Dr. Chand Midha _________________________ _________________________ Faculty Reader Dean of the Graduate School Mr. Scott Johnston Dr. George R. Newkome _________________________ _________________________ School Director Date Dr. Ann Usher ii ABSTRACT The Baroque Era can be considered the “golden age” of trumpet playing in Western Music. Recently, there has been a revival of interest in Baroque trumpet works, and while the research has grown accordingly, the implications of that research require further examination. Musicians need to be able to give this factual evidence a context, one that is both modern and historical. The treatises of Cesare Bendinelli, Girolamo Fantini, and J.E. Altenburg are valuable records that provide insight into the early development of the trumpet. There are also several important modern resources, most notably by Don Smithers and Edward Tarr, which discuss the historical development of the trumpet. One obstacle for modern players is that the works of the Baroque Era were originally played on natural trumpet, an instrument that is now considered a specialty rather than the standard. Trumpet players must thus find ways to reconcile the inherent differences between Baroque and current approaches to playing by combining research from early treatises, important trumpet publications, and technical and philosophical input from performance practice essays.
    [Show full text]
  • Donepezil-Induced Cervical Dystonia in Alzheimer's Disease: a Case
    □ CASE REPORT □ Donepezil-induced Cervical Dystonia in Alzheimer’s Disease: A Case Report and Literature Review of Dystonia due to Cholinesterase Inhibitors Ken Ikeda, Masaru Yanagihashi, Masahiro Sawada, Sayori Hanashiro, Kiyokazu Kawabe and Yasuo Iwasaki Abstract We herein report an 81-year-old woman with Alzheimer’s disease (AD) in who donepezil, a cholinesterase inhibitor (ChEI), caused cervical dystonia. The patient had a two-year history of progressive memory distur- bance fulfilling the NINCDS-ADRDA criteria for probable AD. Mini-Mental State Examination score was 19/30. The remaining examination was normal. After a single administration of donepezil (5 mg/day) for 10 months, she complained of dropped head. Neurological examination and electrophysiological studies sup- ported a diagnosis of cervical dystonia. Antecollis disappeared completely at 6 weeks after cessation of done- pezil. Dystonic posture can occur at various timings of ChEI use. Physicians should pay more attention to rapidly progressive cervical dystonia in ChEI-treated AD patients. Key words: Alzheimer’s disease, cholinesterase inhibitor, donepezil, cervical dystonia, dropped head, Pisa syndrome (Intern Med 53: 1007-1010, 2014) (DOI: 10.2169/internalmedicine.53.1857) Introduction Case Report Tardive dystonia syndrome is known as the complication An 81-year-old woman developed a progressive global in- of prolonged treatment with antipsychotic medications, par- tellectual deterioration for two years and visited our depart- ticularly classic antipsychotics. Pisa syndrome or pleurotho- ment. The first score of Mini-Mental State Examination tonus is a distinct form of tardive dystonia characterized by (MMSE) was 19/30. The remaining neurological examina- abnormal, sustained posturing with flexion of the neck and tion was normal, showing no parkinsonism.
    [Show full text]