CASE REPORT


Exacerbation of Mirror Movement Disorder: A Complex Case of Childhood-onset Mirror Movements Aggravated by Essential Tremors, and Parkinson's Disease



Sara Zarei1, 6, *, Farnoush Nasouri2, Setareh Kamali3, Shivani Patel3, Rahma Jamil4, Ayymen Y Amaar4, 5, Ahmed Mohamed1, Rojeen Zarei6, Sadiq Altamimi1
1 Department of Neurology, The Neurology Group Institution, Pomona, CA, USA
2 Department of Biology, University of California Irvine, Irvine, CA, USA
3 Department of Medicine, Western University of Health Sciences, Pomona, CA, USA
4 Keck Graduate Institution, Henry E. Riggs School of Applied Life Sciences, Claremont, CA, USA
5 Department of Medicine, Burrell College of Osteopathic Medicine, NM, USA
6 Department of Biology, University of Arizona, Arizona, USA


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Creative Commons License
© 2024 The Author(s). Published by Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Neurology, The Neurology Group Institution, Pomona, CA, USA; E-mail: drzarei@tnginc.org


Abstract

Background

Mirror movement (MM), also known as bimanual synkinesis, is characterized by simultaneous involuntary movements of homologous muscles accompanying voluntary movements of contralateral body regions. MM can be observed in various neurological conditions, including cerebral palsy, corticobasal syndrome, Parkinson's disease, certain types of symptomatic epilepsies, Creutzfeldt-Jakob's disease, Huntington's disease, and others.

Case Description

A 52-year-old female with a history of epileptic seizures, essential tremors and mild MM was presented to a neurology clinic for seizure management. She had a long-standing history of seizures since childhood. Initial neurological examination revealed mild MM disorder. During the follow up visits, patient’s mirror movements were exacerbated months before she was diagnosed with Parkinson’s disease. Multiple antiepileptic drug regiments along with Carbidopa-levodopa were used and dose adjustments were done during follow up visits to help stabilize the patient’s symptoms.

Conclusion

In conclusion, this case highlights the progressive nature of mirror movement disorder (MMD) and its association with other neurological conditions, such as epilepsy, essential tremors, and Parkinson's disease. The primary aim of this study was to showcase that individuals with early childhood onset of MMD may experience a deterioration of their condition as they acquire additional neurological disorders, such as essential tremors or Parkinson's disease. Moreover, this study seeks to elucidate how the exacerbation of mirror movement symptoms in such cases can serve as an early indicator of the onset of Parkinson's disease. Medication adjustments played a crucial role in managing the patient's symptoms, emphasizing the importance of individualized treatment plans and close monitoring.

Keywords: Cerebral palsy, Corticobasal syndrome, Creutzfeldt-Jakob's disease, Congenital mirror movement disorder, Epilepsy, Essential tremors, Huntington's disease, Mirror movement disorder, Parkinson's disease.