Divergent Recovery Paths in Musicians' Dystonia.

Background: Musician's dystonia, characterized by a loss of voluntary motor control during performance, predominantly manifests as two forms: Musician's Hand Dystonia (MHD) and embouchure dystonia (ED). ED involves more muscle groups compared to MHD, complicating diagnosis and treatment. Moreover, treatment options for MHD are either not viable for ED, such as botulinumtoxin injections, or less effective in ED, such as anticholinergic drugs. Methods: This study aimed to compare long-term subjective playing abilities at the onset of dystonia and after treatment between ED and MHD patients. We also evaluated the variation in subjective playing ability over time between the groups. Results: Findings revealed that playing ability at onset and the current playing ability are significantly lower in ED than in MHD. Notably, a significant improvement in playing ability over time was observed solely in MHD. Additionally, fewer ED patients sought therapeutic interventions, underscoring a scarcity of treatment options. Discussion: The results highlight a poorer prognosis for ED compared to MHD, likely due to the increased muscle involvement in ED and limited compensatory mechanisms available to these patients, emphasizing an urgent need for alternative therapeutic strategies for those affected by ED.