What is it?
Embouchure dystonia is a term used to describe a type of dystonia that affects brass and woodwind players. The term embouchure refers to the adjustment of the mouth to fit the mouthpiece of a wind instrument. The anatomy of this form of dystonia includes muscles of the mouth, face, jaw, and tongue.
The abnormal movements that characterise embouchure dystonia are often very subtle and occur only while the musicians is playing or buzzing into the mouthpiece. Most brass players use a combination of puckering and smiling to play. At least twelve muscles are involved in positioning the mouth in this way, not including the equally complicated structure of the tongue and jaw. Pinpointing the most important muscles necessary for shaping the mouth to play a brass or woodwind instrument is difficult.
- Symptoms of embouchure dystonia may include:
- Air leaks at the corners of the mouth, sometimes worse in higher registers and accompanied by a noticeable tremor.
- Involuntary, abnormal contractions of the muscles in the face;
- Involuntary puckering;
- Excessive elevation of the corners of the mouth;
- Involuntary closing of the mouth.
Some musicians’ difficulties are limited to sustained notes in particular registers or to certain passages at specific speeds. The dystonia is typically painless but may elicit intense psychological stress.
If embouchure dystonia causes any type of impairment, it is because muscle contractions interfere with normal function. Features such as cognition, strength, and the senses, including vision and hearing, are normal. While dystonia is not fatal, it is a chronic disorder and prognosis is difficult to predict.
Embouchure dystonia is believed to be due to abnormal functioning of the basal ganglia, which are deep brain structures involved with the control of movement. The basal ganglia assist in initiating and regulating movement. What goes wrong in the basal ganglia is still unknown. An imbalance of dopamine, a neurotransmitter in the basal ganglia, may underlie several different forms of dystonia, but much more research needs to be done for a better understanding of the brain mechanisms involved with dystonia.
Musicians may perceive the early symptoms of dystonia as the result of faulty technique or lack of sufficient preparation. Therefore, many musicians intensify rehearsal and practice sessions and do not seek medical help until the condition is quite pronounced.
Diagnosis of embouchure dystonia is based on information from the affected individual and the physical and neurological examination by a neurologist who specialises in movement disorders.
Currently there is no cure for dystonia, but treatments are available to help to ease the symptoms related to the disorder including spasms, pain, and disturbed postures. Working with your doctor, an individualised strategy for treatment can be developed.
Treatment may include rehabilitative methods that attempt to restrain the nervous system to perform on an instrument without triggering symptoms.
Oral medications, including Artane (benzhexol), Rivotril (clonazepam), and Lioresal (baclofen), are often used to treat segmental and generalised dystonias and may offer some relief for focal dystonias. Botulinum toxin is an option, but the anatomy of the area must be carefully considered to avoid unacceptable oral weakness.
Dystonia and its emotional offshoots affect every aspect of a person’s life – how we think, the way we act, and how we cope. By educating yourself with information, you have taken the first step in dealing with dystonia.
Stress is an inevitable part of life, and although it clearly does not cause dystonia, it can aggravate dystonia symptoms.
Like anyone whose life and career are affected by dystonia, musicians may feel the impact of the disorder at a very deep level. A decreased ability to perform may strike at the very core of a musician’s livelihood and personality.
Sometimes depression can be a byproduct of dystonia. Depression may aggravate symptoms and make them worse, but, often, treating depression can result in an improvement of dystonia. It is important to remember that depression is a disorder; it is treatable and not a reflection of one’s self.
To help address these needs, Musicians with Dystonia (MWD) was founded in 2000 by a former professional French Horn player Glen Estrin diagnosed with emboucher dystonia and Steven Frucht, MD in partnership with the Dystonia Medical Research Foundation
The group is dedicated to serving the special needs of musicians affected by task-specific focal dystonia, particularly hand and embouchure dystonias. Musicians with Dystonia is a group of individuals committed to dystonia awareness, education, and research on behalf of both individual musicians and the greater dystonia community.
Many people are experiencing similar symptoms. Reassurance from family, friends, and others who have dystonia is beneficial. Sharing experiences at support group meetings offers encouragement, camaraderie, and the latest information about new treatments and medical advances.