Distonía del músico: fenomenología y desencadenantes vinculados a la ejecución musical / Focal dystonia in musicians: Phenomenology and musical triggering factors

Las distonías se definen como una contracción conjunta, sostenida e involuntaria de músculos agonistas y antagonistas, que puede causar torsión, movimientos involuntarios anormales repetitivos y/o posturas anormales. Un grupo especial de distonías son las conocidas como ocupacionales, que incluyen trastornos distónicos desencadenados por una actividad motora repetitiva, relacionada con la actividad profesional o tarea específica. Los músicos son una población especialmente vulnerable a este tipo de distonías que se presentan como una pérdida de coordinación y control motor voluntario de movimientos altamente entrenados en la interpretación musical. Nuestro objetivo es describir una serie clínica de distonías focales en músicos evaluados y tratados en nuestro centro. Pacientes y métodos: Se presentan los datos de una serie clínica de 12 músicos con distonía ocupacional; se describen sus antecedentes y fenomenología, así como su evolución después de de la terapia. Resultados: Antecedentes demográficos: edad promedio 34,8 ± 11,8 años, 10 hombres (83,3%) y 2 mujeres (16,7%). Antecedentes médicos: antecedentes traumáticos en segmento distónico, 6 pacientes (50%); antecedentes familiares de enfermedades neurológicas en parientes de primer grado, 6 pacientes (50%); antecedentes laborales según categoría musical, 8 pacientes (66,6%) eran músicos clásicos y 4 pacientes (33,3%) eran músicos populares. Fenomenología: El cuadro distónico se caracterizó por presentarse a una edad promedio de inicio de 28,2 ± 11,3 años (rango 18-57 años). En 11 pacientes el segmento afectado fue la mano (91,7%). De todos los músicos consultados, un total de 9 (75%) recibió terapia. En la mayoría de los pacientes se describen desencadenantes específicos de la ejecución musical, asociados a requerimientos de control motor fino. Cabe mencionar que el 50% de los músicos tratados mantuvo su actividad laboral o puesto en la orquesta a la que pertenecía. Conclusiones: La mayoría de nuestros hallazgos fenomenológicos son coherentes con la literatura actualmente disponible. Sin embargo, nos parece destacable la presencia de desencadenantes atribuibles a requerimientos específicos de la ejecución musical, ligados a la participación del control motor fino

Dystonias are defined as a joint sustained and involuntary contraction of agonist and antagonist muscles, which can cause torsion, repetitive abnormal involuntary movements, and/or abnormal postures. One special group of dystonias are those known as occupational, which include dystonia disorders triggered by a repetitive motor activity associated with a specific professional activity or task. Musicians are a population particularly vulnerable to these types of dystonia, which are presented as a loss of coordination and voluntary motor control movements highly trained in musical interpretation. Our aim is to describe a clinical series of focal dystonias in musicians evaluated and treated in our centre. Patients and methods: Data is presented on a clinical series of 12 musicians with occupational dystonia. Their history and phenomenology are described, as well as well as their outcome after therapy. Results: Demographic details: Mean age 34.8 ± 11.8 years, 10 males (83.3%) and 2 females (16.7%). Clinical history: History of trauma in dystonic segment, 6 patients (50%); family history of neurological diseases in first-degree relatives, 6 patients (50%); occupational history according to music category, 8 patients (66.6%) were classical musicians and 4 patients (33.3%) were popular musicians. Phenomenology: The dystonia syndrome was characterised by having a mean age of onset of 28.2 ± 11.3 years (range 18-57 years). The segment affected was the hand (91.7%) in 11patients. Of all the musicians seen in the clinic, 9 of them (75%) received therapy. The majority of patients appeared to have triggering factors specific to musical execution and linked to the requirement of fine motor control. It should be mentioned that 50% of the musicians treated maintained their professional activity or position in the orchestra to which they belonged. Conclusions: The majority of our phenomenological findings are consistent with those reported in the current literature. However, it is worth mentioning the presence of triggering factors attributed to the specific requirements of performing music, linked to the participation of fine motor control

[Focal dystonia in musicians: Phenomenology and musical triggering factors]. / Distonía del músico: fenomenología y desencadenantes vinculados a la ejecución musical.

Dystonias are defined as a joint sustained and involuntary contraction of agonist and antagonist muscles, which can cause torsion, repetitive abnormal involuntary movements, and/or abnormal postures. One special group of dystonias are those known as occupational, which include dystonia disorders triggered by a repetitive motor activity associated with a specific professional activity or task. Musicians are a population particularly vulnerable to these types of dystonia, which are presented as a loss of coordination and voluntary motor control movements highly trained in musical interpretation. Our aim is to describe a clinical series of focal dystonias in musicians evaluated and treated in our centre. PATIENTS AND METHODS: Data is presented on a clinical series of 12 musicians with occupational dystonia. Their history and phenomenology are described, as well as well as their outcome after therapy. RESULTS: Demographic details: Mean age 34.8 ± 11.8 years, 10 males (83.3%) and 2 females (16.7%). CLINICAL HISTORY: History of trauma in dystonic segment, 6 patients (50%); family history of neurological diseases in first-degree relatives, 6 patients (50%); occupational history according to music category, 8 patients (66.6%) were classical musicians and 4 patients (33.3%) were popular musicians. PHENOMENOLOGY: The dystonia syndrome was characterised by having a mean age of onset of 28.2 ± 11.3 years (range 18-57 years). The segment affected was the hand (91.7%) in 11 patients. Of all the musicians seen in the clinic, 9 of them (75%) received therapy. The majority of patients appeared to have triggering factors specific to musical execution and linked to the requirement of fine motor control. It should be mentioned that 50% of the musicians treated maintained their professional activity or position in the orchestra to which they belonged. CONCLUSIONS: The majority of our phenomenological findings are consistent with those reported in the current literature. However, it is worth mentioning the presence of triggering factors attributed to the specific requirements of performing music, linked to the participation of fine motor control.

Distonía focales en los músicos / Focal dystonia in musicians

Introducción: Un grupo especial de distonía focal son las conocidas como ocupacionales, las que incluyen trastornos distónicos desencadenados por una actividad motora repetitiva, íntimamente relacionada con la actividad profesional o tarea específica que realiza el afectado. En este sentido los músicos son una población especialmente vulnerable a esta patología, que se presenta durante la ejecución de movimientos altamente entrenados. Objetivo: En este manuscrito se revisa la fisiopatología y sus implicancias terapéuticas.Desarrollo: Las bases fisiopatológicas de la distonía focal del músico aún no se conocen completamente. Sin embargo, gracias al aporte de estudios neurofisiológicos y de neuroimágenes funcionales, existe creciente evidencia de alteraciones en el procesamiento de información sensorial, integración sensorio-motora, procesos corticales y subcorticales de inhibición, que subyacen a esta patología.Desarrollo: Clínicamente, se caracteriza por aparición de contracción muscular involuntaria y se asocia a pérdida del control motor durante la ejecución musical. Es de aparición gradual y ocasionalmente pueden existir antecedentes de lesiones musculoesqueléticas o posturas no fisiológicas que anteceden la aparición de los síntomas. El examen neurológico es usualmente normal, aunque pueden desarrollarse posturas distónicas sutiles espontáneamente o con movimientos que involucran los segmentos afectados. La distonía permanece focal y no se generaliza.Conclusiones: El tratamiento se basa en la utilización de múltiples estrategias para el manejo de la distonía, con resultado variables. Si bien no se ha definido una terapia especifica, existen principios generales que se combinan en cada situación buscando obtener resultados. Esto incluye intervenciones desde una perspectiva farmacológica, manejo con toxina botulínica, técnicas de reentrenamiento sensorial, entre otras (AU)

Introduction: A special group of focal dystonia is that known as occupational, which include dystonic disorders triggered by repetitive motor activity, closely associated with the professional activity of a specific task that the affected person performs. In this sense, musicians are a population particularly vulnerable to this disorder, which is presented during the execution of highly trained movements. Objective: This article reviews the pathophysiology of focal dystonia and its therapeutic implications. Development: The pathophysiological basis of focal dystonia in the musician is still not well established. However, due to the contribution of neurophysiological studies and functional neuroimaging, there is growing evidence of anomalies in the processing of sensory information, sensory-motor integration, cortical and subcortical inhibitory processes, which underline this disease. Development: Clinically, it is characterised by the appearance of involuntary muscle contractions, and is associated with loss of motor control while practicing music. It is a gradual appearance and sometimes there may be a history of musculoskeletal injuries or non-physiological postures preceding the appearance of the symptoms. The neurological examination is usually normal, although subtle dystonic postures can develop spontaneously or with movements that involve the affected segments. The dystonia remains focal and is not generalised. Conclussions: Treatment is based on using multiple strategies for the management of the dystonia, with variable results. Although a specific therapy has not been defined, there are general principles that are combined in each situation looking for results. This includes, among others, pharmacological interventions, management with botulinum toxin, and sensory re-training techniques (AU)

Focal dystonia in musicians.

INTRODUCTION: A special group of focal dystonia is that known as occupational, which include dystonic disorders triggered by repetitive motor activity, closely associated with the professional activity of a specific task that the affected person performs. In this sense, musicians are a population particularly vulnerable to this disorder, which is presented during the execution of highly trained movements. OBJECTIVE: This article reviews the pathophysiology of focal dystonia and its therapeutic implications. DEVELOPMENT: The pathophysiological basis of focal dystonia in the musician is still not well established. However, due to the contribution of neurophysiological studies and functional neuroimaging, there is growing evidence of anomalies in the processing of sensory information, sensory-motor integration, cortical and subcortical inhibitory processes, which underline this disease. Clinically, it is characterised by the appearance of involuntary muscle contractions, and is associated with loss of motor control while practicing music. It is a gradual appearance and sometimes there may be a history of musculoskeletal injuries or non-physiological postures preceding the appearance of the symptoms. The neurological examination is usually normal, although subtle dystonic postures can develop spontaneously or with movements that involve the affected segments. The dystonia remains focal and is not generalised. CONCLUSIONS: Treatment is based on using multiple strategies for the management of the dystonia, with variable results. Although a specific therapy has not been defined, there are general principles that are combined in each situation looking for results. This includes, among others, pharmacological interventions, management with botulinum toxin, and sensory re-training techniques.

[Risk factors associated with the development of motor complications in Parkinson's disease. A study in a Chilean population]. / Factores de riesgo asociados con el desarrollo de complicaciones motoras en la enfermedad de Parkinson. Experiencia en poblacion chilena.

INTRODUCTION: The treatment of Parkinson's disease (PD) is based on the use of levodopa and/or dopaminergic agonists. This treatment is associated with motor complications in around 50% of the patients over 5 years of treatment. Numerous risk factors have been related to the onset of this motor complications. AIM: To describe the prevalence and risk factors associated with the occurrence of motor complications in our population. PATIENTS AND METHODS: PD patients in control in a movement disorders center were consecutively recruited. Using a multivariate logistic regression model the risk factors associated with the onset of MC were determined. RESULTS: 124 patients were evaluated. Mean age was 66,2 +/- 10,1 years, the years of PD evolution were 8,1 +/- 5,2 years, the on UPDRS score was 27,7 +/- 14,8 points. A 62% of the patients presented at least one motor complication, a 52% with wearing off and a 47,2% dyskinesias. Both motor complications were present in 39%. The multivariate analysis showed that that female sex and the dose of levodopa equivalents were the risk factors for the occurrence of dyskinesias. For the wearing off the main risk factor were the years of evolution of the PD. CONCLUSIONS: This study shows that the time of evolution of the PD is the main risk factor for the wearing off and the female sex and the dose of levodopa equivalents are the risk factor for the development of dyskinesias. These results are in agreement with the previously reported in the literature for other populations.

Factores de riesgo asociados con el desarrollo de complicaciones motoras en la enfermedad de Parkinson. Experiencia en población chilena / Risk factors associated with the development of motor complications in Parkinson disease. A study in a chilean population

Introducción. El tratamiento de la enfermedad de Parkinson (EP) se basa principalmente en el uso de levodopa y/o agonistas dopaminérgicos. Este tratamiento se asocia con complicaciones motoras aproximadamente en el 50% de los pacientes a los cinco años. Existen diversos factores de riesgo para el desarrollo de estas complicaciones descritos en otras poblaciones. Objetivo. Describir la prevalencia y factores de riesgo para la aparición de complicaciones motoras en nuestra población de portadores de EP. Pacientes y métodos. Consecutivamente se reclutaron portadores de EP. Mediante un modelo de regresión logística multivariada se determinaron los factores de riesgo asociados con el desarrollo de las complicaciones motoras. Resultados. Se evaluaron 124 pacientes, con una edad media de 66,2 ± 10,1 años, tiempo medio de evolución de la EP de 8,1 ± 5,2 años, y estado motor on mediante UPDRS-III de 27,7 ± 14,8 puntos. Un 62% presentó alguna complicación motora, un 52% deterioro de fin de dosis, un 47,2% discinesias y un 39% ambas complicaciones motoras. El análisis multivariado mostró que el sexo femenino y la dosis de equivalentes de levodopa son los principales factores de riesgo para la aparición de discinesias, mientras que el tiempo de evolución lo es para el desarrollo de deterioro de fin de dosis. Conclusiones. El tiempo de evolución de la EP es el principal factor de riesgo para el desarrollo de deterioro de fin de dosis, mientras que la dosis de fármacos dopaminérgicos y el sexo femenino son los principales para el desarrollo de discinesias. Estos resultados obtenidos en nuestra población son similares a los comunicados en otras series

Introduction. The treatment of Parkinson’s disease (PD) is based on the use of levodopa and/or dopaminergic agonists. This treatment is associated with motor complications in around 50% of the patients over 5 years of treatment. Numerous risk factors have been related to the onset of this motor complications. Aim. To describe the prevalence and risk factors associated with the occurrence of motor complications in our population. Patients and methods. PD patients in control in a movement disorders center were consecutively recruited. Using a multivariate logistic regression model the risk factors associated with the onset of MC were determined. Results. 124 patients were evaluated. Mean age was 66,2 ± 10,1 years, the years of PD evolution were 8,1 ± 5,2 years, the on UPDRS score was 27,7 ± 14,8 points. A 62% of the patients presented at least one motor complication, a 52% with wearing off and a 47,2% dyskinesias. Both motor complications were present in 39%. The multivariate analysis showed that that female sex and the dose of levodopa equivalents were the risk factors for the occurrence of dyskinesias. For the wearing off the main risk factor were the years of evolution of the PD. Conclusions. This study shows that the time of evolution of the PD is the main risk factor for the wearing off and the female sex and the dose of levodopa equivalents are the risk factor for the development of dyskinesias. These results are in agreement with the previously reported in the literature for other populations

[Risk factors associated to the presentation of episodes of major depression in a population of outpatients with Parkinson's disease]. / Factores de riesgo asociados con la presentación de episodios depresivos mayores en una población ambulatoria de pacientes con enfermedad de Parkinson.

INTRODUCTION: Depression is a frequently occurring problem in Parkinson's disease (PD). The purpose of this study is to describe the characteristics of episodes of major depression (EMD) in a population of outpatients with PD and the risk factors linked to their appearance. PATIENTS AND METHODS: We conducted an open study involving 85 patients with PD; their mean age was 65.8 +/- 12.3 years and the mean length of time since disease onset was 7.2 +/- 5 years. Data that was collected included information from the patient record, evaluation with the Motor Examination section of the Unified PD Rating Scale (UPDRS-III), the Parkinson Mini-Mental test, the Neuropsychiatric Inventory (NPI) and the short version of Beck's Depression Inventory (BDI). EMD were diagnosed clinically by means of a semi-structured interview that allowed us to examine the symptoms that are included in the DSM-IV criteria for diagnosis of EMD. RESULTS: In 21 cases (24.7%) DSM-IV criteria for EMD were satisfied, with a BDI score (mean +/- standard deviation) of 17.5 +/- 6.2. In 64 cases (75.3%) who did not fulfil the criteria for EMD, the BDI score was 6.4 +/- 4.7 (p < 0.001). The items on the UPDRS-III related to the dopaminergic response in patients with EMD were 24.9 +/- 11.9 and in patients without EMD the values were 21.2 +/- 10.9 (NS). Those not related to the dopaminergic response in patients with EMD were 9.9 +/- 5.3 and in those without EMD the values were 6.2 +/- 4.6 (p < 0.001). CONCLUSION: In our sample, the presence of motor symptoms that do not respond to levodopa in patients with PD is a risk factor for the appearance of EMD.

Factores de riesgo asociados con la presentación de episodios depresivos mayores en una población ambulatoria de pacientes con enfermedad de Parkinson / Risk factors associated to the presentation of episodes of major depression in a population of outpatients with parkinson’s disease

Introducción. La depresión es un problema frecuente en la enfermedad de Parkinson (EP). El objetivo de este estudio es describirlas características de los episodios depresivos mayores (EDM) en una población ambulatoria de pacientes con EP y los factores de riesgo asociados con su aparición. Pacientes y métodos. En un estudio abierto se reclutaron 85 pacientes con EP, edad media 65,8± 12,3 años y tiempo medio de evolución de la enfermedad 7,2 ± 5años. Se obtuvo historia clínica, evaluación con escala unificada para la EP sección motora (UPDRS-III), test minimental de Parkinson, inventario neuropsiquiátrico (NPI) e inventario para la depresión de Beck (IDB) versión corta. El diagnóstico de EDM se realizó clínicamente mediante una entrevista semiestructurada en la que se exploraron los síntomas incluidos en los criterios DSM-IV. Resultados. En 21 casos (24,7%) se cumplían los criterios DSM-IV para un EDM, con un IDB (media ± DE) de 17,5 ± 6,2. En 64 casos (75,3%)que no cumplían con los criterios para un EDM, el IDB fue de 6,4 ±4,7 (p < 0,001). Los ítems de la UPDRS-III relacionados con la respuestado paminérgica en los pacientes con EDM fueron de 24,9 ±11,9, y en los pacientes sin EDM, de 21,2 ± 10,9 (no significativo).Los no relacionados con la respuesta dopaminérgica en los pacientes con EDM fueron de 9,9 ± 5,3, y sin EDM, 6,2 ± 4,6 (p < 0,001).Conclusión. En nuestra muestra, la presencia de síntomas motores que no responden a levo dopa en pacientes con EP es un factor de riesgo para la aparición de un EDM (AU)

Introduction. Depression is a frequently occurring problem in Parkinson’s disease (PD). The purpose of this study is to describe the characteristics of episodes of major depression (EMD) in a population of outpatients with PD and the risk factors linked to their appearance. Patients and methods. We conducted an open study involving 85 patients with PD; their mean age was 65.8 ± 12.3 years and the mean length of time since disease onset was 7.2 ± 5 years. Data that was collected included information from the patient record, evaluation with the Motor Examination section of the Unified PD Rating Scale(UPDRS-III), the Parkinson Mini-Mental test, the Neuropsychiatric Inventory (NPI) and the short version of Beck's Depression Inventory (BDI). EMD were diagnosed clinically by means of a semi-structured interview that allowed us to examine the symptoms that are included in the DSM-IV criteria for diagnosis of EMD. Results. In 21 cases (24.7%) DSM-IV criteria for EMD were satisfied, with a BDI score (mean ± standard deviation) of 17.5 ± 6.2. In 64 cases (75.3%) who did not fulfil the criteria for EMD, the BDI score was 6.4 ± 4.7 (p < 0.001). The items on the UPDRS-III related to the dopaminergic response in patients with EMD were 24.9 ± 11.9 and in patients without EMD the values were 21.2 ± 10.9 (NS). Those not related to the dopaminergic response in patients with EMD were 9.9 ± 5.3 and in those without EMD the values were 6.2 ± 4.6(p < 0.001). Conclusion. In our sample, the presence of motor symptoms that do not respond to levodopa in patients with PD is a risk factor for the appearance of EMD (AU)

[Evaluation of cognitive impairment in a population of patients with Parkinson's disease by means of the mini mental Parkinson test]. / Evaluación del deterioro cognitivo en una población de pacientes con enfermedad de Parkinson mediante el test minimental Parkinson.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative disorder in which motor symptoms are initially predominant; however, as the disease progresses, cognitive deterioration becomes more evident. Tests designed to detect cognitive impairment are therefore needed. AIMS: The aim of the study was to assess the cognitive status of a population of patients with PD by means of the Mini Mental Parkinson test (MMP). PATIENTS AND METHODS: In 110 patients with idiopathic PD, with a mean age of 66.4 +/- 10.2 years and an average history of 8.8 +/- 5.8 years of the disease, the mean severity of the disease as measured by the unified PD rating scale (UPDRS-III) was 26.2 +/- 12.9. RESULTS: There were 20 (18.2%) subjects with dementia according to DSM-IV criteria, with a score of 20.4 +/- 6.4 on the MMP. Of the 90 patients who did not have dementia, 47 cases displayed cognitive impairment, without the presence of disorders affecting their activities of daily living, who scored 25.3 +/- 4.7 points on the MMP, and 43 cases did not show any kind of cognitive impairment, with 28.0 +/- 3.3 points on the MMP; these differences were statistically significant p < 0.001. Results according to age brackets showed a decrease in MMP with age and more especially so concerning memory functioning. As to severity, there is a cognitive decline, in particular with regard to memory, orientation and abstraction. CONCLUSIONS: Cognitive capacity is seen to decline with age and the severity of the disease.

Evaluación del deterioro cognitivo en una población de pacientes con enfermedad de Parkinson mediante el test minimental Parkinson / Evaluation of cognitive impairment in a population of patients with Parkinson’s disease by means of the mini mental Parkinson test

Introducción. La enfermedad de Parkinson (EP) es un cuadro neurodegenerativo en el que inicialmente predominan los síntomas motores; sin embargo, con la progresión de la enfermedad se evidencian deterioros cognitivos. Es necesario usar test dirigidos a la detección del deterioro cognitivo. Objetivos. Evaluar el estado cognitivo de una población de pacientes con EP mediante la administración del test minimental Parkinson (MMP). Pacientes y métodos. En 110 pacientes con EP idiopática, con una edad media de 66,4 10,2 años y un tiempo medio de evolución de la enfermedad de 8,8 5,8 años, la gravedad media de la enfermedad con la escala unificada para la valoración de la EP (UPDRS-III) es 26,2 12,9. Resultados. Los sujetos que presentan demencia según los criterios del DSM-IV son 20 (18,2%), con una puntuación de 20,4 6,4 en el MMP. De los 90 pacientes que no presentan demencia, 47 casos muestran deterioro cognitivo, sin presencia de afectación de las actividades de la vida diaria, con 25,3 4,7 puntos en el MMP, y aquellos que no presentan ninguna forma de déficit cognitivo son 43 casos, con 28,0 3,3 puntos en el MMP, diferencias estadísticamente significativas p 0,001. Los resultados según el intervalo de edad demuestran una disminución del MMP con la edad y, especialmente, en la función memoria. En relación con la gravedad, existe un declive cognitivo especialmente en las funciones orientación, memoria y abstracción. Conclusiones. Se evidencia una disminución de la capacidad cognitiva con relación a la edad y la gravedad de la enfermedad

Introduction. Parkinson’s disease (PD) is a neurodegenerative disorder in which motor symptoms are initially predominant; however, as the disease progresses, cognitive deterioration becomes more evident. Tests designed to detect cognitive impairment are therefore needed. Aims. The aim of the study was to assess the cognitive status of a population of patients with PD by means of the Mini Mental Parkinson test (MMP). Patients and methods. In 110 patients with idiopathic PD, with a mean age of 66.4 ± 10.2 years and an average history of 8.8 ± 5.8 years of the disease, the mean severity of the disease as measured by the unified PD rating scale (UPDRS-III) was 26.2 ± 12.9. Results. There were 20 (18.2%) subjects with dementia according to DSM-IV criteria, with a score of 20.4 ± 6.4 on the MMP. Of the 90 patients who did not have dementia, 47 cases displayed cognitive impairment, without the presence of disorders affecting their activities of daily living, who scored 25.3 ± 4.7 points on the MMP, and 43 cases did not show any kind of cognitive impairment, with 28.0 ± 3.3 points on the MMP; these differences were statistically significant p < 0.001. Results according to age brackets showed a decrease in MMP with age and more especially so concerning memory functioning. As to severity, there is a cognitive decline, in particular with regard to memory, orientation and abstraction. Conclusions. Cognitive capacity is seen to decline with age and the severity of the disease

[Diagnosis of Parkinson's disease]. / Diagnóstico de la enfermedad de Parkinson.

INTRODUCTION: Presently article carried out an up-to-date revision of the literature on the diagnosis of the Parkinson's disease, considering the clinical aspects, those of neuroradiology and the genetic diagnosis. DEVELOPMENT: The Parkinson's disease is the second most common neurodegenerative disorder and despite of the important development that has taken place in the last years as much in molecular genetics and neuroradiology, the diagnosis of this disease continuous being eminently clinical, the appropriate knowledge of the calls 'cardinal signs' and its application in the diagnosis increases the possibility that this it is guessed right, regrettably the definitive approach is only obtained in the autopsy. The genetic studies and of neuroradiology mainly are presented as tools for a more reliable differential diagnosis with other parkinsonism forms and the knowledge of these techniques can be useful in the taking of therapeutic decisions or of the affected patient's integral treatment. They have also been different monogenic forms in origin to the sporadic form of the illness. CONCLUSION: The knowledge and search of the preponderant clinical signs increases the capacity of diagnostic of the illness, in the same way the appropriate use of additional methods of investigation, mainly in the differential diagnosis.

Diagnóstico de la enfermedad de Parkinson / Diagnosis of parkinson's disease

Introducción. En el presente artículo se realiza una revisión actualizada de la literatura sobre el diagnóstico de la enfermedad de Parkinson, y se consideran los aspectos clínicos, la neuroimagen y el diagnóstico genético. Desarrollo. La enfermedad de Parkinson es la segunda enfermedad neurodegenerativa más común y, a pesar del importante desarrollo que se ha producido en los últimos años, tanto en genética molecular como en neurorradiología, el diagnóstico de esta enfermedad es todavía eminentemente clínico; el conocimiento adecuado de los llamados 'signos cardinales' y su aplicación en el diagnóstico aumentan la posibilidad que éste acierte; lamentablemente, el criterio definitivo sólo se obtiene en la autopsia. Los estudios genéticos y de neurorradiología, sobre todo, se presentan como herramientas para un diagnóstico diferencial más fiable con respecto a otras formas de parkinsonismo, y el conocimiento de estas técnicas puede resultar útil en la toma de decisiones terapéuticas o en el tratamiento integral del paciente afectado. Además, se han encontrado formas monogénicas diferentes en origen a la forma esporádica de la enfermedad. Conclusión. El conocimiento y búsqueda de los signos clínicos preponderantes aumenta la capacidad de diagnóstico de la enfermedad, e, igualmente, el uso adecuado de métodos adicionales de investigación, sobre todo en el diagnóstico diferencial (AU)

Introduction. Presently article carried out an up-to-date revision of the literature on the diagnosis of the Parkinson’s disease, considering the clinical aspects, those of neuroradiology and the genetic diagnosis. Development. The Parkinson’s disease is the second most common neurodegenerative disorder and despite of the important development that has taken place in the last years as much in molecular genetics and neuroradiology, the diagnosis of this disease continuous being eminently clinical, the appropriate knowledge of the calls ‘cardinal signs’ and its application in the diagnosis increases the possibility that this it is guessed right, regrettably the definitive approach is only obtained in the autopsy. The genetic studies and of neuroradiology mainly are presented as tools for a more reliable differential diagnosis with other parkinsonism forms and the knowledge of these techniques can be useful in the taking of therapeutic decisions or of the affected patient’s integral treatment. They have also been different monogenics forms in origin to the sporadic form of the illness. Conclusion. The knowledge and search of the preponderant clinical signs increases the capacity of diagnostic of the illness, in the same way the appropriate use of additional methods of investigation, mainly in the differential diagnosis (AU)

[Guitarist's cramp: management with sensory re-education]. / Distonía del guitarrista: tratamiento con reeducación sensorial.

INTRODUCTION: Dystonia is defined as a sustained co-contraction of agonistic and antagonistic muscles that can cause twisting, twitching and abnormal postures. Occupational dystonias are included in a special group of pathologies that are secondary to a repeated effort related to the professional activity carried out by the sufferer, as can occur in guitarists, violinists and trumpet players, for example. Its pathophysiology includes descriptions of disorders affecting the peripheral and central nervous systems. Studies conducted in monkeys have shown that, through sensory stimulation, repeated movements can give rise to central anomalies in the somatosensory cortex, with growth of the receptive fields that are stimulated and deformation of the separations between those fields. CASE REPORT: We describe the case of a professional guitarist with a seven-year history of symptoms. A neurological examination revealed a co-contraction in the right hand that triggered the extension of the index and little fingers, which made it difficult for him to play his instrument. The patient was submitted to sensory re-education therapy with the use of a splint and a two-month routine of exercises. The response was evaluated using a subjective scale of the patient's symptoms and measurements of the maximum angles of flexion and extension of the affected fingers. Both methods reduced the patient's discomfort and allowed him to exhibit greater skill when playing the guitar. CONCLUSIONS: Occupational dystonias produced by repeated stimulation present alterations in the sensory region of the cortex, with the involvement of motor performance that improves with sensory re-education therapy.

Distonía del guitarrista: tratamiento con reeducación sensorial / Guitarist´s cramp: treatment with sensory re-education

Introducción. La distonía se define como una cocontracción de músculos agonistas y antagonistas sostenida que puede causar torsión, movimientos involuntarios y posturas anormales. Las distonías ocupacionales corresponden a un grupo especial de patología secundarias a un esfuerzo repetitivo, que se relaciona con la actividad profesional que realiza el afectado, como es el caso de guitarristas, violinistas y trompetistas. En su fisiopatología se describen alteraciones en el sistema nervioso periférico y central. Estudios en monos han demostrado que los movimientos repetitivos mediante una estimulación sensitiva pueden producir anomalías centrales en la corteza somatosensorial, con un crecimiento de los campos receptivos estimulados y deformación de las separaciones entre dichos campos. Caso clínico. Se presenta el caso de un guitarrista profesional con síntomas de siete años de evolución, cuyo examen neurológico evidencia una cocontractura en su mano diestra que provoca la extensión de los dedos índice y meñique, lo que dificulta la ejecución de su instrumento. Se realiza un tratamiento de reeducación sensorial con el uso de una férula y esquemas de ejercicio durante dos meses. Se evalúa la respuesta mediante una escala subjetiva de sus síntomas y mediciones de los ángulos máximos de flexión y extensión de los dedos afectados. Ambos métodos revelan una disminución de sus molestias y mejor destreza al tocar la guitarra. Conclusiones. Las distonías ocupacionales producidas por una estimulación repetitiva presentan alteraciones en la zona sensitiva cortical, con afectación del rendimiento motor, que se benefician con terapia de reeducación sensorial (AU)

Introduction. Dystonia is defined as a sustained co-contraction of agonistic and antagonistic muscles that can cause twisting, twitching and abnormal postures. Occupational dystonias are included in a special group of pathologies that are secondary to a repeated effort related to the professional activity carried out by the sufferer, as can occur in guitarists, violinists and trumpet players, for example. Its pathophysiology includes descriptions of disorders affecting the peripheral and central nervous systems. Studies conducted in monkeys have shown that, through sensory stimulation, repeated movements can give rise to central anomalies in the somatosensory cortex, with growth of the receptive fields that are stimulated and deformation of the separations between those fields. Case report. We describe the case of a professional guitarist with a seven-year history of symptoms. A neurological examination revealed a co-contraction in the right hand that triggered the extension of the index and little fingers, which made it difficult for him to play his instrument. The patient was submitted to sensory re-education therapy with the use of a splint and a two-month routine of exercises. The response was evaluated using a subjective scale of the patient’s symptoms and measurements of the maximum angles of flexion and extension of the affected fingers. Both methods reduced the patient’s discomfort and allowed him to exhibit greater skill when playing the guitar. Conclusions. Occupational dystonias produced by repeated stimulation present alterations in the sensory region of the cortex, with the involvement of motor performance that improves with sensory re-education therapy (AU)