Table 1
Clinical characteristics of drummers with dystonia from multiple cohorts.
| COHORT | SEX | RACE (CURRENT SERIES ONLY) | AGE AT ONSET, YEARS | AGE AT PRESENTATION/EVALUATION, YEARS | SIDE AFFECTED | DOMINANT HAND | INSTRUMENTS (MUSICAL STYLE) | PHENOMENOLOGY WITH INSTRUMENT | TREMOR REPORTED | SPREAD TO OTHER TASKS | BENEFICIAL INTERVENTIONS |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Current series, No. 1 [Video, Case 1] | M | Caucasian | 23 | 27 | Left | Unknown | Drum, Xylophone | Ext 2, 3, 4, 5 | Yes | Yes – typing | None (trial ofcarbidopa/levodopa without benefit, unknown dose) |
| Current series, No. 2 [Video, Case 2] | M | Caucasian | 41 | 44 | Right | Right | Drum set (Pop) | Flex 2, 3, 4, 5; wrist ulnar deviation | No | Yes – Golfing, brushing teeth, holding knife | None (lorazepam without benefit, unknown dose; referred for botulinum toxin injections but lost to follow up and results unknown) |
| Current series, No. 3 [Video, Case 3] | M | Caucasian | 43 | 45 | Right | Unknown | Indian tabla, classical percussion | Flex 2 | No | No | External sensory trick with tape and orthopedic finger splint |
| Current series, No. 4 [Video, Case 4] | M | Caucasian | 22 | 25 | Left | Right | Classical Percussion | Irregular tremor at wrist; Flex 3, 4, 5 (PIP/DIP); Wrist Flex, radial deviation | Yes | No | Declined botulinum toxin injections or other treatment trials. |
| Current series, No. 5 | M | Caucasian | 53 | 54 | Left | Right | Drums (jazz, rock) | Wrist Flex and ulnar deviation | Yes | Yes – putting on glasses, drinking from cup | None (multiple treatments tried including carbidopa/levodopa 600 mg daily, clonazepam, trihexyphenidyl 30 mg/daily, Botulinum toxin A injections, with EMG guidance – mild benefit, but limited by weakness: 25 units to each of left FCU, left pronator quadratus, left ECU; occupational therapy, limb immobilization) |
| Current series, No. 6 | M | Caucasian | 19 | 20 | Both | Right | Drums (multiple genres) | Right: Flex 4, 5 (PIP); Left: Flex 4, 5 (PIP), wrist Ext and ulnar deviation | No | No | Good benefit with botulinum toxin A injections using EMG guidance – Right side: FCU 20 units, FDS 25 units. Left side: FCR 15 units, FCU 20 units, EDC 15 units. (Carbidopa/levodopa 450 mg daily with no benefit) |
| Current series, No. 7 | M | Caucasian | 33 | 42 | Right | Right | Drums, xylophone, vibraphone (multiple genres) | Ext 2, abduction of 5; loosened thumb grip; tightness in forearm and wrist | No | No | Trihexyphenidyl 24 mg daily, modest benefit. Botulinum toxin A injections, with EMG guidance, 60–70% improvement: Right EPL 7.5 units; Right EIP 7.5 units; Right ECR 10 units |
| Current series, No. 8 | M | Unknown | 39 | 42 | Right | Right | Indian tabla | Wrist ulnar deviation | No | No | Referred for botulinum toxin injections, but lost to follow up and results unknown |
| Current series, No. 9 | M | Unknown | 31 | 34 | Left | Right | Classical percussion | Ext 4, 5 (at MCP), wrist Ext and radial deviation | No | Yes – holding stick between hands | None (Clonazepam, uncertain dose; trihexyphenidyl 6 mg daily without benefit; referred for botulinum toxin injections, but results unknown) |
| Current series, No. 10 | M | Unknown | 45 | 52 | Left | Right | African-Cuban and African-Caribbean drumming | Ext 2, 3, 4 (at PIP, DIP); Flex 2, 3, 4 (at MCP); wrist Flex, shoulder elevation | Yes | Yes – handling fork, newspaper | None (Received 2 cycles of botulinum toxin injections elsewhere without benefit; unknown injection pattern) |
| Current series, No. 11 | M | Unknown | 39 | 48 | Left | Unknown | Timpani (Classical) | Ext 3, 4, 5 (at PIP); Flex 3, 4, 5 (at MCP); abduction of digits; wrist ulnar deviation | No | No | Diazepam with modest benefit – unknown dose. |
| Current series, No. 12 | M | Caucasian | 34 | 38 | Right | Right | Snare drum (Multiple genres) | Flex 2, 3, 4, tremor when writing | Yes | Yes – writing, brushing teeth | Propranolol LA 60 mg daily modest benefit; carbidopa/levodopa 250 mg daily without benefit. |
| Lederman 2004 [6] | M | 34 | 35 | Right | Left | Drum set (Jazz/Rock) | Right forearm supination, wrist Flex | No | Yes – in opposite hand | Trihexyphenidyl (modest) | |
| Lederman 2004 | M | 21 | 22 | Right | Left | Classical Percussion | Right forearm tightening, thumb slides off drumstick | No | No | None | |
| Lederman 2004 | M | 36 | 39 | Right | Right | Drum set (Country Music) | Right wrist Flex, thumb abduction/extension | No | Yes | None | |
| Lederman 2004 | M | 22 | 23 | Left | Right | Unspecified – Master’s Degree performance program | Left forearm supination and tremor | Yes | No | None | |
| Lederman 2004 | F | 42 | 52 | Both (Left > Right) | Right | Classical Percussion (Snare drum most affected; also xylophone and other mallet instruments) | Left wrist Ext, tremor; mild right side tremor | Yes | Unknown | Low dose propranolol; softer mallets; quit snare drum | |
| Lederman 2004 | M | 51 | 53 | Left | Right | Drum set (Jazz) | Left wrist Flex and ulnar deviation | No | Yes | Limb immobilization trial (unknown long term improvement) | |
| Ragothaman 2004 [11] | M | 31 | 32 | Right | Unknown | Tabla | Ext 1, Flex 2, 3, 4, 5, forearm pronation, wrist ulnar deviation | No | No | Botulinum toxin injections (onabotulinumtoxinA) | |
| Ragothaman 2004 | M | 45 | 47 | Both (R > L) | Unknown | Tabla | Right: wrist Flex and ulnar deviation; Left finger flexion | No | No | Botulinum toxin injections (onabotulinumtoxinA – minimal improvement) | |
| Brandfonbrener 1995 [17] | F | ? 19 | Left | Right | Unspecified | Left Flex 3, Ext 4, 5 | No | Unknown | |||
| Brandfonbrener 1995 | M | 32 | Left | Right | Unspecified | Left Flex 3, loss of control of 4th/5th digits | No | Unknown | |||
| Brandfonbrener 1995 | F | 25 | Right | Right | Unspecified | Right Ext 3, 4, 5 | No | Unknown | |||
| Sussman 2015 [18] | Unknown | Unknown | Left | Unknown | Unknown | Left wrist flexion, shoulder abduction | No | ||||
| Conti 2008 [19] | M | 22 | Left | Right | Drums | Tremor | Yes | Unknown | |||
| Rosset-Llobet 2012 [9] | M | 23 | 23 | Left leg | Unknown | Drum set (Jazz) | Toe extension, left toe, ankle, knee tension | No | No | Sensory Motor Retraining | |
| Rosset-Llobet 2012 | M | 20 | 22 | Both legs | Unknown | Drum set (Rock) | Toe flexion, heel elevation | No | No | Modified practice routines | |
| Lee 2014 [8] | M | 26 | 28 | Right leg | Unknown | Drum set (Heavy Metal) | Thigh tightness; coactivation of hamstring and quadriceps on EMG | No | No | IncobotulinumtoxinA – slight effect | |
| Katz 2013 [7] | M | 45 | 75 | Right leg | Unknown | Drum set | Plantar flexion | No | Yes | AFO; botulinum toxin; Functional Electrical Stimulation of peroneal nerve | |
| Asahi 2018 [20] | M | 22 | 37 | Right hand and foot | Left | Drum set | Reported difficulty with control of fine movements in foot; right forearm tightness | No | Yes – writing | Improvement with left Vo thalamotomy | |
| Schirinzi 2018 [21] | M | 46 | 49 | Left hand | Right | Unknown | Loss of dexterity in left hand; wrist flexion and internal rotation of forearm | No | Yes | Slight benefit with levodopa (<20%); greater benefit with trihexyphenidyl (6 mg daily) and botulinum toxin injections. | |
| Song 2020 [22] | M | 59 | 59 | Left arm | Unknown | Janggu (traditional Korean drum) | Left arm and wrist flexion | No | Yes, in other tasks involving flexion of left arm | Partial benefit with botulinum toxin injections |
[i] Abbreviations: DIP (distal interphalangeal); Ext (Extension); F (female); Flex (Flexion); M (male); MCP (metacarpophalangeal); PIP (proximal interphalangeal).
Upper extremity digits represented by numbers 1 (thumb) to 5.
Video 1
Clinical features of drummers’ dystonia in cases 1–4.