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Abstract
Musician's dystonia (MD) is a focal adult-onset dystonia most commonly involving the hand. It has much greater relative prevalence than non-musician’s focal hand dystonias, exhibits task specificity at the level of specific musical passages, and is a particularly difficult form of dystonia to treat. For most MD patients, the diagnosis confirms the end of their music performance careers. Research on treatments and pathophysiology is contingent upon measures of motor function abnormalities. In this review, we comprehensively survey the literature to identify the rating scales used in MD and the distribution of their use. We also summarize the extent to which the scales have been evaluated for their clinical utility, including reliability, validity, sensitivity, specificity to MD, and practicality for a clinical setting. Out of 135 publications, almost half (62) included no quantitative measures of motor function. The remaining 73 studies used a variety of choices from among 10 major rating scales. Most used subjective scales involving either patient or clinician ratings. Only 25% (18) of the studies used objective scales. None of the scales has been completely and rigorously evaluated for clinical utility. Whether studies involved treatments or pathophysiologic assays, there was a heterogeneous choice of rating scales used with no clear standard. As a result, the collective interpretive value of those studies is limited because the results are confounded by measurement effects. We suggest that the development and widespread adoption of a new clinically useful rating scale is critical for accelerating basic and clinical research in MD.
GLOSSARY
- ADDS=
- Arm Dystonia Disability Scale;
- DES=
- Dystonia Evaluation Scale;
- FAM=
- Frequency of Abnormal Movements scale;
- FHD=
- focal hand dystonia;
- FM=
- Fahn-Marsden scale;
- GDS=
- Global Dystonia Rating Scale;
- IOI=
- interonset interval;
- MD=
- musician's dystonia;
- MIDI=
- Musical Instrument Digital Interface;
- sdIOI=
- SD of interonset intervals;
- TCS=
- Tubiana and Chamagne Scale;
- TRE=
- Test Repertoire Evaluation;
- UDRS=
- Unified Dystonia Rating Scale;
- VAS=
- visual analog scale
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received December 14, 2012.
- Accepted in final form April 22, 2013.
- © 2013 American Academy of Neurology
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