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Quattrone A, Latorre A, Magrinelli F, Mulroy E, Rajan R, Neo RJ, Quattrone A, Rothwell JC, Bhatia KP. A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment. Mov Disord Clin Pract 2023; 10:1243-1252. [PMID: 37772299 PMCID: PMC10525069 DOI: 10.1002/mdc3.13798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 09/30/2023] Open
Abstract
In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.
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Affiliation(s)
- Andrea Quattrone
- Institute of NeurologyUniversity “Magna Graecia”CatanzaroItaly
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Ray Jen Neo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of NeurologyHospital Kuala LumpurKuala LumpurMalaysia
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Graecia”CatanzaroItaly
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
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Liu P, Yuan Y, Zhang N, Liu X, Yu L, Luo B. Mirror Movements in Acquired Neurological Disorders: A Mini-Review. Front Neurol 2021; 12:736115. [PMID: 34616356 PMCID: PMC8488104 DOI: 10.3389/fneur.2021.736115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Mirror movements (MMs) are specifically defined as involuntary movements occurring on one side of homologous muscles when performing unilateral movements with the contralateral limb. MMs have been considered a kind of soft neurological signs, and the persistence or reappearance of MMs in adults is usually pathologic. In addition to some congenital syndrome, MMs have been also described in age-related neurological diseases including pyramidal system diseases (e.g., stroke, amyotrophic lateral sclerosis) and extrapyramidal disorders (e.g., Parkinson's disease, essential tremor). With the advances in instrumentation and detection means, subtle or subclinical MMs have been deeply studied. Furthermore, the underlying mechanism is also being further elucidated. In this mini-review, we firstly discuss the MM examination means, and then review the literature regarding MMs in individuals with acquired neurological disorders, in order to further understand the pathogenesis of MMs.
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Affiliation(s)
- Ping Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Yuan
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ning Zhang
- Department of Neurology, Pujiang People's Hospital, Jinhua, China
| | - Xiaoyan Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Yu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wagner D, Eslinger PJ, Sterling NW, Du G, Lee EY, Styner M, Lewis MM, Huang X. Lexical-semantic search related to side of onset and putamen volume in Parkinson's disease. BRAIN AND LANGUAGE 2020; 209:104841. [PMID: 32818719 PMCID: PMC8189666 DOI: 10.1016/j.bandl.2020.104841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Parkinson's disease (PD) is characterized by dopaminergic cell loss and reduced striatal volume. Prior studies have demonstrated striatal involvement in access to lexical-semantic knowledge and damage to this structure may be evident in the lexical properties of responses. Semantic fluency task responses from early stage, non-demented PD participants with right (PD-R) or left (PD-L) lateralizing symptoms were compared to matched controls on lexical properties (word frequency, age of acquisition) and correlated with striatal volumes segmented from T1-weighted brain MR images. PD-R participants produced semantic fluency responses of a lower age of acquisition than PD-L and control participants (p < 0.05). PD-R age of acquisition responses correlated positively with putamen volume (p < 0.05), while age of acquisition of responses correlated negatively with caudate volume in controls (p < 0.05). Findings provide evidence for a role of the striatum in lexical-semantic access and qualitative changes in lexical access in select PD patients.
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Affiliation(s)
- Daymond Wagner
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Paul J Eslinger
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Neural and Behavioral Sciences, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Nicholas W Sterling
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Guangwei Du
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Eun-Young Lee
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Martin Styner
- Departments of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, United States; Departments of Computer Science, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, United States.
| | - Mechelle M Lewis
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
| | - Xuemei Huang
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States; Departments of Kinesiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, United States.
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Pandey S, Rawat C. Clinical signs in movement disorders: Phenomenology of mirror movements. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Solmaz B, Özyurt MG, Ata DB, Akçimen F, Shabsog M, Türker KS, Dalçik H, Algin O, Başak AN, Özgür M, Çavdar S. Assessment of the corticospinal fiber integrity in mirror movement disorder. J Clin Neurosci 2018; 54:69-76. [PMID: 29907388 DOI: 10.1016/j.jocn.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/03/2018] [Indexed: 10/14/2022]
Abstract
Mirror movements are unintended movements occurring on one side of the body that mirror the contralateral voluntary ones. It has been proposed that mirror movements occur due to abnormal decussation of the corticospinal pathways. Using detailed multidisciplinary approach, we aimed to enlighten the detailed mechanism underlying the mirror movements in a case subject who is diagnosed with mirror movements of the hands and we compared the findings with the unaffected control subjects. To evaluate the characteristics of mirror movements, we used several techniques including whole exome sequencing, computed tomography, diffusion tensor imaging and transcranial magnetic stimulation. Computed tomography showed the absence of a spinous process of C5, fusion of the body of C5-C6 vertebrae, hypoplastic dens and platybasia of the posterior cranial fossa. A syrinx cavity was present between levels C3-C4 of the spinal cord. Diffusion tensor imaging of the corticospinal fibers showed disorganization and minimal decussations at the lower medulla oblongata. Transcranial magnetic stimulation showed that motor commands were distributed to the motor neuron pools on the left and right sides of the spinal cord via fast-conducting corticospinal tract fibers. Moreover, a heterozygous missense variation in the deleted in colorectal carcinoma gene has been observed. Developmental absence of the axonal guidance molecules or their receptors may result in abnormalities in the leading of the corticospinal fibers. Clinical evaluations and basic neuroscience techniques, in this case, provide information for this rare disease and contribute to our understanding of the normal physiology of bimanual coordination.
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Affiliation(s)
- Bilgehan Solmaz
- Department of Neurosurgery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | | | - Demir Berk Ata
- Department of Molecular Biology and Genetics, School of Medicine, Koç University, Istanbul, Turkey
| | - Fulya Akçimen
- Neurodegeneration Research Laboratory, Suna and İnan Kıraç Foundation, Boğaziçi University, İstanbul, Turkey
| | - Mohammed Shabsog
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Kemal Sıtkı Türker
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Hakkı Dalçik
- Department of Preclinical Science, Anatomy Unit, Faculty of Medicine, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Oktay Algin
- Department of Radiology, Bilkent University, Ankara, Turkey
| | - Ayşe Nazlı Başak
- Neurodegeneration Research Laboratory, Suna and İnan Kıraç Foundation, Boğaziçi University, İstanbul, Turkey
| | - Merve Özgür
- Department of Anatomy, School of Medicine, Koç University, Istanbul, Turkey
| | - Safiye Çavdar
- Department of Anatomy, School of Medicine, Koç University, Istanbul, Turkey.
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Trouillard O, Koht J, Gerstner T, Moland S, Depienne C, Dusart I, Méneret A, Ruiz M, Dubacq C, Roze E. Congenital Mirror Movements Due to RAD51: Cosegregation with a Nonsense Mutation in a Norwegian Pedigree and Review of the Literature. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:424. [PMID: 27830107 PMCID: PMC5099496 DOI: 10.7916/d8bk1cnf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
Abstract
Background Autosomal dominant congenital mirror movements (CMM) is a neurodevelopmental disorder characterized by early onset involuntary movements of one side of the body that mirror intentional movements on the contralateral side; these persist throughout life in the absence of other neurological symptoms. The main culprit genes responsible for this condition are RAD51 and DCC. This condition has only been reported in a few families, and the molecular mechanisms linking RAD51 mutations and mirror movements (MM) are poorly understood. Methods We collected demographic, clinical, and genetic data of a new family with CMM due to a truncating mutation of RAD51. We reviewed the literature to identify all reported patients with CMM due to RAD51 mutations. Results We identified a heterozygous nonsense mutation c.760C>T (p.Arg254*) in eight subjects: four with obvious and disabling MM, and four with a mild phenotype. Including our new family, we identified 32 patients from 6 families with CMM linked to RAD51 variants. Discussion Our findings further support the involvement of RAD51 in CMM pathogenesis. Possible molecular mechanisms involved in CMM pathogenesis are discussed.
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Affiliation(s)
- Oriane Trouillard
- Sorbonne Universités, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Jeanette Koht
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | | | - Christel Depienne
- Département de Médicine translationnelle et Neurogénétique, IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France; Laboratoires de génétique, Institut de génétique médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Isabelle Dusart
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Neurosciences Paris Seine - Institut de Biologie Paris Seine (NPS - IBPS), 75005 Paris, France
| | - Aurélie Méneret
- Sorbonne Universités, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marta Ruiz
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Caroline Dubacq
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Neurosciences Paris Seine - Institut de Biologie Paris Seine (NPS - IBPS), 75005 Paris, France
| | - Emmanuel Roze
- Sorbonne Universités, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
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Chatterjee P, Banerjee R, Choudhury S, Mondal B, Kulsum MU, Chatterjee K, Kumar H. Mirror movements in Parkinson's disease: An under-appreciated clinical sign. J Neurol Sci 2016; 366:171-176. [DOI: 10.1016/j.jns.2016.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/15/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Kamis D, Stratton L, Calvó M, Padilla E, Florenzano N, Guerrero G, Molina Rangeon B, Molina J, de Erausquin GA. Sex and laterality differences in parkinsonian impairment and transcranial ultrasound in never-treated schizophrenics and their first degree relatives in an Andean population. Schizophr Res 2015; 164:250-5. [PMID: 25735637 PMCID: PMC4409537 DOI: 10.1016/j.schres.2015.01.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/18/2015] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
Abstract
We tested the hypothesis that loss of substantia nigra neurons in subjects at risk of schizophrenia (1), as reflected by midbrain hyperechogenicity (2) and parkinsonian motor impairment (3), is asymmetric and influenced by sex. We evaluated 62 subjects with never-treated chronic schizophrenia, 80 of their adult, unaffected first degree relatives and 62 healthy controls (matched by sex and age to the cases), part of an Andean population of Northern Argentina. Parkinsonism was scored blindly using UPDRS-3 (Unified Parkinson's Disease Rating Scale) on videotaped exams by 2 independent raters. Transcranial ultrasound was performed by an expert sonographist blind to subject condition with a 2.5 MHz transducer through a temporal bone window. Quantification of echogenic area was carried out on saved images by a different evaluator. We found a significant difference in parkinsonian motor impairment between patients, their relatives as well as controls. All three groups showed worse parkinsonism on the left side than the right, corresponding with increased echogenicity on the right substantia nigra compared with the left. Females had significantly more right echogenicity than males, and patients and unaffected relatives were significantly more echogenic than controls on that side. On the left, only female patients had significant echogenicity. Our data supports the notion that unaffected relatives of schizophrenic subjects have increased parkinsonism and concomitant brainstem abnormalities which may represent a vulnerability to the disease. Both motor and brainstem abnormalities are asymmetric and influenced by sex.
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Affiliation(s)
- Danielle Kamis
- Roskamp Laboratory of Brain Development, Modulation and Repair, University of South Florida, United States
| | - Lee Stratton
- Roskamp Laboratory of Brain Development, Modulation and Repair, University of South Florida, United States
| | - María Calvó
- Hospital Neuropsiquiátrico Néstor Sequeiros, Ministerio de Salud, Provincia de Jujuy, Argentina; Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Argentina
| | - Eduardo Padilla
- Hospital Neuropsiquiátrico Néstor Sequeiros, Ministerio de Salud, Provincia de Jujuy, Argentina; Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Argentina
| | - Néstor Florenzano
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Argentina; Instituto de Morfología J. J. Naón, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Gonzalo Guerrero
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Argentina
| | - Beatriz Molina Rangeon
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Argentina
| | - Juan Molina
- Roskamp Laboratory of Brain Development, Modulation and Repair, University of South Florida, United States
| | - Gabriel A de Erausquin
- Roskamp Laboratory of Brain Development, Modulation and Repair, University of South Florida, United States.
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Poisson A, Ballanger B, Metereau E, Redouté J, Ibarolla D, Comte JC, Bernard HG, Vidailhet M, Broussolle E, Thobois S. A functional magnetic resonance imaging study of pathophysiological changes responsible for mirror movements in Parkinson's disease. PLoS One 2013; 8:e66910. [PMID: 23825583 PMCID: PMC3692538 DOI: 10.1371/journal.pone.0066910] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/12/2013] [Indexed: 11/20/2022] Open
Abstract
Mirror movements correspond to involuntary movements observed in the limb contralateral to the one performing voluntary movement. They can be observed in Parkinson's disease (PD) but their pathophysiology remains unclear. The present study aims at identifying their neural correlates in PD using functional magnetic resonance imaging. Ten control subjects and 14-off drug patients with asymmetrical right-sided PD were included (8 with left-sided mirror movements during right-hand movements, and 6 without mirror movements). Between-group comparisons of BOLD signal were performed during right-hand movements and at rest (p<0.005 uncorrected). The comparison between PD patients with and without mirror movements showed that mirror movements were associated with an overactivation of the insula, precuneus/posterior cingulate cortex bilaterally and of the left inferior frontal cortex and with a deactivation of the right dorsolateral prefrontal cortex, medial prefrontal cortex, and pre-supplementary motor area and occipital cortex. These data suggest that mirror movements in Parkinson's disease are promoted by: 1- a deactivation of the non-mirroring inhibitory network (dorsolateral prefrontal cortex, pre-supplementary motor area); 2- an overactivation of prokinetic areas (notably the insula). The concomitant overactivation of a proactive inhibitory network (including the posterior cingulate cortex and precuneus) could reflect a compensatory inhibition of mirror movements.
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Affiliation(s)
- Alice Poisson
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France
| | - Bénédicte Ballanger
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- CERMEP Imagerie du vivant, Lyon, France
| | - Elise Metereau
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- CERMEP Imagerie du vivant, Lyon, France
| | | | | | | | - Hélène Gervais Bernard
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France
| | - Marie Vidailhet
- Fédération de Neurologie, CRICM UMR-S UPMC/INSERM 975; CNRS UMR 7225, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Emmanuel Broussolle
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France
| | - Stéphane Thobois
- Université de Lyon, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France
- CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France
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Cox BC, Cincotta M, Espay AJ. Mirror movements in movement disorders: a review. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-59-398-1. [PMID: 23440079 PMCID: PMC3569961 DOI: 10.7916/d8vq31dz] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 12/30/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mirror movements (MM) are involuntary movements of homologous muscles during voluntary movements of contralateral body regions. While subtle mirroring can be present in otherwise healthy adults, overt MM may be common in many movement disorders. Examining these collective findings may further our understanding of MM and help define their usefulness as a clinical sign. METHODS We sought to review English language research articles examining the presence, clinical significance, and/or pathophysiology of MM in Parkinson's disease (PD), corticobasal syndrome (CBS), essential tremor (ET), focal hand dystonia, Creutzfeldt-Jakob's disease (CJD), and Huntington's disease. When available, MM in these disorders were compared with those of healthy age-matched controls and congenital disorders such as Klippel-Feil syndrome and X-linked Kallman's syndrome. RESULTS Clinical presentation of MM is common in asymmetric parkinsonian disorders (early PD, CBS) and manifests differently depending on the side affected (less affected hand in PD, more affected hand in CBS, either hand in ET, and both hands in healthy adults and congenital disorders), stage of disease (early, asymmetric PD and CJD), and presence of concomitant mirror-like overflow phenomena (focal dystonia and CBS-associated alien hand). In general, uncrossed descending corticospinal projections (congenital MM) and/or abnormal activation of the motor cortex ipsilateral to the voluntary task (most acquired MM), i.e., activation of the normal crossed corticospinal pathway, are required for the generation of MM. DISCUSSION MM are common motor phenomena and present differently in several acquired (mostly neurodegenerative) and congenital movement disorders. Future studies on MM will enhance the clinical diagnosis of selected movement disorders and contribute to our understanding of the normal physiology of bimanual coordination.
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Affiliation(s)
- Benjamin C. Cox
- University of Cincinnati Neuroscience Institute, Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, United States of America
| | | | - Alberto J. Espay
- University of Cincinnati Neuroscience Institute, Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, United States of America
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Lewis MM, Du G, Sen S, Kawaguchi A, Truong Y, Lee S, Mailman RB, Huang X. Differential involvement of striato- and cerebello-thalamo-cortical pathways in tremor- and akinetic/rigid-predominant Parkinson's disease. Neuroscience 2011; 177:230-9. [PMID: 21211551 DOI: 10.1016/j.neuroscience.2010.12.060] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/22/2010] [Accepted: 12/29/2010] [Indexed: 12/20/2022]
Abstract
Parkinson's disease (PD) presents clinically with varying degrees of resting tremor, rigidity, and bradykinesia. For decades, striatal-thalamo-cortical (STC) dysfunction has been implied in bradykinesia and rigidity, but does not explain resting tremor in PD. To understand the roles of cerebello-thalamo-cortical (CTC) and STC circuits in the pathophysiology of the heterogeneous clinical presentation of PD, we collected functional magnetic resonance imaging (fMRI) data from 17 right-handed PD patients [nine tremor predominant (PDT) and eight akinetic-rigidity predominant (PDAR)] and 14 right-handed controls while they performed internally-guided (IG) sequential finger tapping tasks. The percentage of voxels activated in regions constituting the STC and CTC [divided as cerebellar hemisphere-thalamo-cortical (CHTC) and vermis-thalamo-cortical (CVTC)] circuits was calculated. Multivariate analysis of variance compared the activation patterns of these circuits between study groups. Compared to controls, both PDAR and PDT subjects displayed an overall increase in the percentage of voxels activated in both STC and CTC circuits. These increases reached statistical significance in contralateral STC and CTC circuits for PDT subjects, and in contralateral CTC pathways for PDAR subjects. Comparison of PDAR and PDT subjects revealed significant differences in ipsilateral STC (P=0.005) and CTC (P=0.043 for CHTC and P=0.003 for CVTC) circuits. These data support the differential involvement of STC and CTC circuits in PD subtypes, and help explain the heterogeneous presentation of PD symptoms. These findings underscore the importance of integrating CTC circuits in understanding PD and other disorders of the basal ganglia.
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Affiliation(s)
- M M Lewis
- Department of Neurology, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Moraschi M, Giulietti G, Giove F, Guardati M, Garreffa G, Modugno N, Colonnese C, Maraviglia B. fMRI study of motor cortex activity modulation in early Parkinson's disease. Magn Reson Imaging 2010; 28:1152-8. [DOI: 10.1016/j.mri.2010.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 03/05/2010] [Accepted: 03/05/2010] [Indexed: 10/19/2022]
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Silvers DS, Menkes DL. Hemibody mirror movements in hemiparkinsonism-hemiatrophy syndrome. J Neurol Sci 2009; 287:260-3. [PMID: 19766249 DOI: 10.1016/j.jns.2009.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 08/28/2009] [Accepted: 08/28/2009] [Indexed: 11/26/2022]
Abstract
Hemiparkinsonism-hemiatrophy syndrome (HPHA) is a relatively rare cause of secondary parkinsonism. Mirror movements (MM) are associated with a variety of congenital and acquired conditions, including some forms of parkinsonism. This report describes a patient with the HPHA phenotype who exhibited MM, a feature that has not been previously reported in this syndrome. Surface electromyography (EMG) was used to illustrate the virtually simultaneous occurrence of voluntary and involuntary movements. Needle EMG was used to diagnose a spinal accessory neuropathy. Pathological mirroring or overflow movement of the orbicularis oculi muscle is also hypothesized. The clinical features are demonstrated on video.
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Affiliation(s)
- David S Silvers
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA.
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Salazar G, Casas E, Oliveras D, Rando A, Sergio P. Ocular-jaw synkinesia in normal, Parkinson's disease, and multiple system atrophy subjects: Clinical and electrophysiological findings. Clin Neurophysiol 2009; 121:94-7. [PMID: 19906558 DOI: 10.1016/j.clinph.2009.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 08/13/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We occasionally observe cranial synkinesias that involve a lateral jaw movement ipsilateral to the horizontal gaze deviation in Parkinson's disease (PD) patients and normal subjects. We term this conjugated movement 'ocular-jaw synkinesia' (OJS). The clinical and electrophysiological features of OJS are described in this study. METHODS Eighty-two subjects were enrolled, 33 PD, 33 non-ill caregivers, and 16 multi system atrophy (MSA-p) patients. The subjects and patients were assessed clinically and electrophysiologically. The data were registered using two scales. The clinical findings were registered using the OJS scale, and the electrophysiological findings were registered using the eyes and chin ipsilateral deviation (ECD) scale. All subjects underwent a video recording. RESULTS Twenty-eight out of the 33 PD patients (84.7%) (P: 0.0141) and 25 out of the 33 normal subjects (83.3%) (P: 0.0144) displayed signs of OJS. None of the MSA-p patients showed signs of OJS, and 13 of the 16 control subjects (81.2%) showed OJS (p: 0.014). Twenty-nine out of the 33 PD patients (87.8%) (P: 0.0123) and 27 out of the 33 normal subjects (90%) (P: 0.0112) showed ECD at the electrophysiological examination. None of the MSA-p patients displayed ECD, showing a strong statistical significance when compared to control subjects (K: 0.0011). CONCLUSIONS OJS is a normal and common synkinetic cranial movement easy to observe in PD and normal subjects on both physical and electrophysiological examinations. In contrast, the MSA-p patients showed no physical or electrophysiological signs of OJS in this study. SIGNIFICANCE The presence of OJS is supportive of the clinical diagnosis of PD; its absence is uncommon in PD and may suggest an alternative Parkinsonism such as MSA-p.
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Affiliation(s)
- Gabriel Salazar
- Hospital Arnau de Vilanova, Department of Neurology, Lleida, Spain.
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Park IS, Song IU, Lee SB, Lee KS, Kim HT, Kim JS. Mirror movements and involuntary homolateral limb synkinesis in a patient with probable Creutzfeldt–Jakob disease. Clin Neurol Neurosurg 2009; 111:380-3. [DOI: 10.1016/j.clineuro.2008.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 11/04/2008] [Accepted: 11/09/2008] [Indexed: 11/16/2022]
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Cincotta M, Ziemann U. Neurophysiology of unimanual motor control and mirror movements. Clin Neurophysiol 2008; 119:744-62. [DOI: 10.1016/j.clinph.2007.11.047] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/17/2007] [Accepted: 11/23/2007] [Indexed: 10/22/2022]
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Ottaviani D, Tiple D, Suppa A, Colosimo C, Fabbrini G, Cincotta M, Defazio G, Berardelli A. Mirror movements in patients with Parkinson's disease. Mov Disord 2007; 23:253-8. [DOI: 10.1002/mds.21825] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Li JY, Espay AJ, Gunraj CA, Pal PK, Cunic DI, Lang AE, Chen R. Interhemispheric and ipsilateral connections in Parkinson's disease: relation to mirror movements. Mov Disord 2007; 22:813-21. [PMID: 17290459 DOI: 10.1002/mds.21386] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Mirror movements (MM) occur in early, asymmetric Parkinson's disease (PD). To examine the pathophysiology of MM in PD, we studied 13 PD patients with MM (PD-MM), 7 PD patients without MM (PD-NM), and 14 normal subjects. Cross-correlogram did not detect common synaptic input to motoneuron pools innervating homologous hand muscles in PD-MM patients. Transcranial magnetic stimulation studies showed no significant difference in ipsilateral motor-evoked potentials between PD-MM patients and normal subjects. The MM side of PD-MM patients showed a slower increase in ipsilateral silent period area with higher level of muscle contraction than the non-MM side and normal subjects. There was less interhemispheric inhibition (IHI) at long interstimulus intervals of 20 to 50 ms in PD-MM than PD-NM. IHI reduced short interval intracortical inhibition in normal subjects and PD-NM, but not in PD-MM. IHI significantly increased intracortical facilitation in PD-MM and PD-NM patients, but not in normal subjects. Our results suggest that MM in PD is due to activation of the contralateral motor cortex. PD-MM patients had reduced transcallosal inhibitory effects on cortical output neurons and on intracortical inhibitory circuits compared to PD-NM patients and controls. These deficits in transcallosal inhibition may contribute to MM in PD patients.
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Affiliation(s)
- Jie-Yuan Li
- Division of Neurology, Department of Medicine, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
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