Neurology

Clinical Activities

The Performing Arts Clinic meets on Wednesday mornings and Saturday afternoons at Brigham and Women's Hospital (BWH). The clinic sees approximately 4-6 new patients and 5-10 follow-up patients weekly. The clinic is limited to musicians. Many of our patients come from outside of the Boston metropolitan region, and about 10% come from other parts of the country or abroad. Most of our patients are instrumental musicians with pain, numbness, tingling, or incoordination of the upper extremities, shoulders, or neck. The most common diagnoses are overuse injury (regional pain syndrome), ulnar nerve entrapment, carpal tunnel syndrome, neck and shoulder pain, thoracic outlet syndrome, and focal dystonia. The majority of our patients are referred for treatment at Performing Arts Physical Therapy and Occupational Therapy in Boston. Diagnostic evaluations include detailed history, physical examination, and observation of performance. A piano is available. Regular and specialized electrodiagnostic testing is performed at BWH. We work in close collaboration with the Hand Surgery program at BWH, under the direction of Dr. Barry Simmons. Patients with focal dystonia are sometimes referred for botulinum toxin treatment at BWH.

Research

The Performing Arts Clinic is a center for research on nerve entrapment syndromes and focal dystonia in musicians. Research includes early electrodiagnosis of mild nerve entrapment syndromes, surgical outcomes in ulnar decompression procedures, pathophysiology of focal dystonia, and functional brain imaging of finger movements in normal, injured, and dystonic musicians. Functional brain imaging research is supported by a grant from the Milton Foundation.

Director

The Performing Arts Clinic was founded and is directed by Michael E. Charness, M.D. Dr. Charness is a graduate of the Johns Hopkins University School of Medicine. He trained in Internal Medicine at the Johns Hopkins Hospital and in Neurology at the University of California, San Francisco, and is board certified in both Neurology and Internal Medicine. He has been treating instrumental musicians since 1984 and co-founded the Health Program for Performing Arts at the University of California, San Francisco in 1986. In 1989, he established the Performing Arts Clinic at the Brigham and Women's Hospital in Boston, MA. He is Associate Professor of Neurology at Harvard Medical School, Associate Chief of Neurology at Brigham and Women's Hospital, and Chief of Neurology at the VA Boston Healthcare System. Dr. Charness is on the editorial board of the journal Medical Problems of Performing Artists and has lectured internationally on the subject of performing arts medicine and injury prevention. He presents annual seminars on injury prevention at the New England Conservatory of Music and the Juilliard School. His publications in this field cover the areas of nerve entrapment and focal dystonia. Dr. Charness is a pianist and performs regularly with his wife and family (http://www.charnessfamily.net ).

Relevent Publications in Performing Arts Medicine

1. CHARNESS ME, Parry GJ, Markison RE, Rosegay H, Barbaro NM. Entrapment neuropathy in musicians. Neurology 1985; 35:74.
2. CHARNESS ME, Barbaro NM, Olney RK, Parry GJ. Occupational cubital tunnel syndrome in instrumental musicians. Neurology 1987; 37:115.
3. CHARNESS ME, The relationship between local injury and focal dystonia in performing artists. Neurology 1989; 39:246
4. CHARNESS ME. Prevention of neurological hand disorders in musicians. Interlude, March-April 1990, 23-25.
5. CHARNESS ME. Unique upper extremity disorders in musicians. In Millender LH, Louis DS Simmons BP, eds. Occupational Disorders of the Upper Extremity. Churchill Livingstone, N.Y., 1992: 227-52.
6. Tarsy D, Sudarsky L, CHARNESS, ME. Limb dystonia following electrical injury. Movement Disorders 1994,9:230-232.
7. Ross MH, CHARNESS ME, Lee D, Logigian EL. Does ulnar neuropathy predispose to focal dystonia? Muscle Nerve 1995, 18:606-611.
8. Gasser T, Bove C, Ozelius L, Hallett M, CHARNESS ME, Hochberg F, Breakefield XO. Haplotype analysis in Ashkenazi Jewish patients with occupational hand dystonia Movement Disorders 1996, 11:163-166.
9. Ross MH and CHARNESS ME. Occupational cramp. in Samuels MA and Feske S. Office Practice of Neurology. Churchill Livingstone, New York, 1996; 678-680.
10. CHARNESS ME, Ross MH, Shefner JM. Ulnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians. Muscle Nerve 1996, 19:431-437
11. Ross MH, CHARNESS ME, Sudarsky L, Logigian EL. Treatment of occupational cramp with botulinum toxin: spread of toxin to adjacent non-injected muscles, Muscle Nerve 1997, 20:593-598.
12. Dawson WJ, CHARNESS ME, Goode DJ, Lederman RJ, Newmark J. What's in a name, terminological issues in performing arts medicine. Medical Problems of Performing Artists, 1998, 13:45-50.
13. Friedman JRL, Klein C, Leung J, Woodward H, Ozelius LJ, Breakefield XO, CHARNESS, ME. The GAG deletion of the DYT1 Gene is infrequent in musicians with focal dystonia, Neurology, 2000, 55:1417-1418
14. ME CHARNESS, G. Schlaug. Cortical activation during finger movements in concert pianists, dystonic pianists, and non-musicians. Neurology 54 (suppl 3), A221, 2000.

Development of Educational Materials

1987 "Occupational Disorders in Musicians", a videotape for the Network for Continuing Medical Education

Selected Presentations

REGIONAL, NATIONAL, AND INTERNATIONAL CONTRIBUTIONS INVITED LECTURES AND SYMPOSIA (since 9/89)

REGIONAL

1989-Longwood Neurology Grand Rounds, Occupational Disorders in Musicians
1989-Hand Conference, Brigham and Women's Hospital, Occupational Disorders in Musicians
1990-Hand Conference, Brigham and Women's Hospital, Focal Dystonia in Musicians
1990-Plastic Surgery Grand Rounds, Massachusetts General Hospital, Hand Disorders in Musicians
1990-Physical Therapy Grand Rounds, Brigham and Women's Hospital, Hand Disorders in Musicians
1991-Harvard University Program for Continuing Medical Education Occupational Cramps, 1 lecture, Boston, MA
1992-Harvard University Program for Continuing Medical Education Occupational Cramps, 1 lecture, Boston, MA
1992-Neurology Grand Rounds, Longwood Neurology Training Program, Neurologic "Hand Disorders in Musicians"
1992-Patient Symposium on Adult Onset Dystonias: Current Therapies and Management, New England Deaconess Hospital, Boston, MA "Hand Dystonias in Musicians"
1993-Harvard University Program for Continuing Medical Education Occupational Cramps, 1 lecture, Boston, MA
1993-Hand Surgery Conference, New England Baptist Hospital, "Neurological Hand Disorders in Musicians"
1994-Harvard University Program for Continuing Medical Education Occupational Cramps, 1 lecture, Boston, MA
1995-Harvard University Program for Continuing Medical Education Occupational Neuropathies, 1 lecture, Boston, MA
1995-Orthopedic Grand Rounds, Shriner's Hospital, Springfield, MA "Management of Ulnar Neuropathy in Musicians"
1995-New England Conservatory of Music "Playing without Pain", Boston, MA
1997-Rheumatology Grand Rounds, Beth Israel Deaconess Medical Center, "Occupational Hand disorders in Musicians", Boston, MA
1997-Brain Awareness Week, Belmont High School, "Your Brain on Music", Belmont, MA
1997-Rehabilitation Grand Rounds, Brigham and Women's Hospital, "Hand Disorders in Musicians", Boston, MA
1998-"Injury Prevention in Musicians" New England Conservatory of Music, Boston MA
1998-Clinical Conference, Lane Health Clinic, Northeastern University, Boston MA. "Occupational Injuries in Musicians"
1999- "Preventing Injury in Musicians" New England Conservatory of Music, Boston, MA
1999-Hand Surgery Grand Rounds, Brigham and Women's Hospital, "Occupational Hand Disorders in Musicians", Boston, MA
2000- "Preventing Injury in Musicians" New England Conservatory of Music, Boston, MA
2000- "Preventing Injury in Musicians" Greater Boston Youth Symphony Orchestra, Boston, MA
2001- "Preventing Injury in Musicians" New England Conservatory of Music, Boston, MA

NATIONAL AND INTERNATIONAL (since 1990)

1991-American Academy of Neurology, Breakfast seminar, "Compressive Mononeuropathies", Boston, MA
1992-American Academy of Neurology, Breakfast seminar, "Compressive Mononeuropathies", San Diego, CA
1992-American Academy of Neurology, Dinner seminar, "Neurological Disorders in Musicians", San Diego, CA
1993-American Academy of Neurology, Breakfast seminar, "Compressive Mononeuropathies", New York, NY
1993-American Academy of Neurology, Dinner seminar, "Neurological Disorders in Musicians", New York, NY
1993-American Academy of Neurology, Symposium, "Pain and Other Causes of Impaired Control in Performing Musicians", New York, NY
1994-12th Annual Conference on the Medical Problems of Musicians and Dancers, "The Relationship Between Focal Dystonia and Nerve Entrapment in Musicians", Aspen CO
1996-Neurology Grand Rounds, University of Pennsylvania, "Ulnar Neuropathy and Focal Dystonia in Musicians", Philadelphia, PA
1996-14th Annual Conference on the Medical Problems of Musicians and Dancers, "Ulnar Neuropathy in Musicians", Aspen CO
1998-American Physical Therapy Association, Combined Sections Meeting, "Ulnar Neuropathy in Musicians", Boston MA
1998-"Preventing Injury in Musicians" Juilliard School, New York, NY
1999- Resident Physician Council Northeast Regional Conference, American Academy of Physical Medicine and Rehabilitation, "Focal Dystonia, Diagnosis and Treatment"Boston MA
1999-"The Causes and Prevention of Playing-related Injuries in Musicians", The Juilliard School, New York, NY
2000-"The Causes and Prevention of Playing-related Injuries in Musicians", The Juilliard School, New York, NY
2001 "Brain Mapping in Musicians", Mansell Bequest Symposium on "Neurology of the Arts", The Medical Society of London, London, England
2002 "Brain Mapping in Musician's Dystonia" International Symposium on Dystonia, Atlanta, GA (invitation accepted)