Congenital mirror movements: lack of decussation of pyramids

Abstract

Sir, We have read with great interest the article published by Gallea et al. (2013), in the November 2013 issue of Brain , regarding the pathophysiological basis of the rare disease named congenital mirror movements (Srour et al. , 2010; Depienne et al. , 2012), that might serve as a model to recognize new aspects of bimanual motor control (Gallea et al. , 2011). We have recently seen a patient with congenital mirror movements and have coincidently studied this disorder using a clinical, neurophysiological and neuroimaging protocol similar to those used by Gallea et al. (2013). This case was presented as a video session at the 5th Meeting of the Movement Disorders Scientific Department of the Brazilian Academy of Neurology, in August 2013, but has not yet been published. Our patient is a 32-year-old right-handed male, with synkinetic distal movements of distal limbs since early childhood, with stable course, and no other movement disorders or neurological abnormalities. The involuntary movements led him to labour impairment as he works as a postman and has difficulties in performing bimanual tasks such as writing on a clipboard or handling a mobile telephone or keyboard. Interestingly, a late acquisition of running abilities was his only neurodevelopmental delay; his parents reporting a preference for jumping instead of running in early childhood \[which may be similar to the Kanga mice hopping gait, with spontaneous mutation in the deleted in colorectal carcinoma ( Dcc ) gene\] (Finger et al. , 2002). His clinical manifestations were classified in the Woods and Teuber Mirror Movements Scale (Woods and Teuber, 1978) as …