Mirror movements in parkinsonism: evaluation of a new clinical sign

Background: Mirror movements (MM) are not widely appreciated in parkinsonism and no report has evaluated this clinical sign in detail. Objectives: To define the parkinsonian clinical features associated with MM in patients with early, asymmetric parkinsonism. Methods: Twenty seven patients with earl...

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Bibliographic Details
Published in:Journal of neurology, neurosurgery and psychiatry Vol. 76; no. 10; pp. 1355 - 1359
Main Authors: Espay, A J, Li, J-Y, Johnston, L, Chen, R, Lang, A E
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01.10.2005
BMJ Publishing Group LTD
BMJ Group
Subjects:
Adult
Aged
Aged, 80 and over
Asymmetry
Cerebrovascular Circulation - physiology
Dopamine
Female
Foot - physiopathology
Functional Laterality - physiology
Humans
LAA
LAL
lateralised Unified Parkinson’s Disease Rating Scale
least affected arm
least affected leg
MAA
MAL
Male
Middle Aged
mirror movements
most affected arm
most affected leg
Motor Cortex - blood supply
Parkinson Disease - diagnosis
Parkinson Disease - epidemiology
Parkinson Disease - physiopathology
Parkinson's disease
Phenomenology
Severity of Illness Index
Synkinesis - diagnosis
Synkinesis - epidemiology
Synkinesis - physiopathology
Unified Parkinson’s Disease Rating Scale
UPDRS
Videotape Recording
ISSN:0022-3050, 1468-330X
Online Access:Get full text
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Summary:Background: Mirror movements (MM) are not widely appreciated in parkinsonism and no report has evaluated this clinical sign in detail. Objectives: To define the parkinsonian clinical features associated with MM in patients with early, asymmetric parkinsonism. Methods: Twenty seven patients with early Parkinson’s disease were evaluated using a standardised videotaping protocol. MM were scored from blinded video assessment using a clinical scale that rates the amplitude, distribution, and proportion of mirroring in the less affected limb. Parkinsonian features were combined into axial and lateralised scores using related items of the Unified Parkinson’s Disease Rating Scale. Results: MM were present in 24 of 27 patients. There was a significant linear correlation between the degree of asymmetry of motor deficits and MM on the less affected side. The effect of asymmetry was greater when the proportional rather than the absolute motor difference between sides was largest. Asymmetry in leg rigidity was the most important examination feature in the prediction of contralateral foot mirroring. Conclusions: MM are a clinical feature of the unaffected or less affected side in mild asymmetric parkinsonism. Their presence may be a useful clinical finding in early parkinsonism.
Bibliography:ark:/67375/NVC-BHJ0JF03-6
local:0761355
istex:D13E43184BAD9EB6EDA9C6298522EEE01DB2C703
Correspondence to:
 Dr A E Lang
 Toronto Western Hospital, Division of Neurology, 399 Bathurst Street, MC 7-413, Toronto, Ontario M5T 2S8, Canada; lang@uhnres.utoronto.ca
PMID:16170075
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ISSN:0022-3050
1468-330X
DOI:10.1136/jnnp.2005.062950