title: Bilateral mirror writing movements (mirror dystonia) in a patient with writer's cramp: functional correlates.
abstract: A recent prospective analysis on writer's cramp showed that up to 44.6% of patients in a series of 65 presented mirror dystonia, defined as involuntary movements of the resting hand, abnormal posture, tremor, and jerks occurring while writing with the opposite hand. A clinical case is presented, with videotape evidence of right-handed writer's cramp, with mirror movements elicited while writing using either hand. Functional magnetic resonance imaging studies are compared both to those of a normal patient and to those from a patient with writer's cramp but lacking mirror dystonia. Widespread bilateral activation of cortical motor areas contralateral to the mirror movements in patients with writer's cramp and mirror movements suggests, that bilateral activation of the primary motor cortex may account for the appearance of these mirror movements. Further studies need to be conducted to determine whether mirror movements in dystonic patients appear as a result of loss of intra- and/or interhemispheric cortical inhibition or are simply a consequence of the sustained effort these patients need to exert while writing using a dystonic hand.
authors.affiliation: Movement Disorders Section, Raul Carrea Institute for Neurological Research FLENI, Buenos Aires, Argentina. mmerello@fleni.org.ar
authors.forename: Marcelo
authors.initials: M
authors.lastname: Merello
authors.forename: Silvina
authors.initials: S
authors.lastname: Carpintiero
authors.forename: Angel
authors.initials: A
authors.lastname: Cammarota
authors.forename: Francisco
authors.initials: F
authors.lastname: Meli
authors.forename: Ramon
authors.initials: R
authors.lastname: Leiguarda
mesh_terms: D004292:Dominance, Cerebral; D020821:Dystonic Disorders / Q000503:physiopathology*; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000503:physiopathology; D010100:Oxygen / Q000097:blood
chemical_list: D010100:Oxygen