Mirror movements in Parkinson's disease: An under-appreciated clinical sign.
BACKGROUND
Mirror movements (MM) have been previously reported in patients with Parkinson's disease (PD). Despite being potentially relevant in PD, MM as a neurological sign have remained less recognized. In this study we critically evaluated the characteristic features of MM and their attributes among a cohort of PD patients from a tertiary care center of eastern part of India.


METHODS
In this analytical cross-sectional study, 70 patients with PD were evaluated using Unified Parkinson's Disease Rating Scale (UPDRS) and a previously used scale to score MM in the OFF and ON phases of l-Dopa therapy. MM was video-recorded for 4 motor tasks (finger- tapping, hand-movement, pronation-supination, rapid ankle-flexion-extension) and scored for the MM attributes i.e. amplitude, distribution and proportion.


RESULTS
A vast majority of PD patients (95.7%) exhibited MM and there was a trend of higher MM score with lesser severity of disease affection. Marked differences in amplitude, distribution and proportion of MM in the upper and lower limbs were evident in response to l-Dopa therapy in certain motor tasks. In addition, less involved limbs exhibited higher MM and the MM scores were higher for lower limb tasks in the ON phase.


CONCLUSIONS
The high prevalence of MM in PD patients and its correlation to disease severity echoed previous studies across the globe. In addition, this study provides evidence for a differential response of MM attributes to l-Dopa. To our knowledge, this is the first study that characterized MM in a cohort of PD patients from India. Our findings suggest the significance of MM as a clinical neurological sign in PD.
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India.
Payel
P
Chatterjee
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India.
Rebecca
R
Banerjee
Department of Pharmacology, College of Medicine and Sagor Dutta Hospital, Kolkata, India.
Supriyo
S
Choudhury
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India.
Banashree
B
Mondal
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India.
Marium Umme
MU
Kulsum
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India.
Koustav
K
Chatterjee
Department of Neurology and RGC Research Centre, Institute of Neurosciences, Kolkata, India. Electronic address: rishi_medicine@yahoo.com.
Hrishikesh
H
Kumar
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007194:India; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects / Q000502:physiology; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D034941:Upper Extremity / Q000503:physiopathology
D000978:Antiparkinson Agents; D007980:Levodopa
Mirror movement; Parkinson's disease; l-Dopa