Ann Rehabil Med.  2019 Aug;43(4):524-529. 10.5535/arm.2019.43.4.524.

Ten-Year Follow-Up of Transcranial Magnetic Stimulation Study in a Patient With Congenital Mirror Movements: A Case Report

• Kim ED
• Kim GW
• Won YH
• Ko MH
• Seo JH
• Park SH

• KMID: 2457761
• DOI: http://doi.org/10.5535/arm.2019.43.4.524

Abstract

Most studies concerning congenital mirror movements (CMMs) have been focused on the motor organization in the distal hand muscles exclusively. To the best of our knowledge, there is no data on motor organization pattern of lower extremities, and a scarcity of data on the significance of forearm and arm muscles in CMMs. Here, we describe the case of a 19-year-old boy presenting mirror movements. In these terms, a 10-year transcranial magnetic stimulation study demonstrated that the motor organization pattern of the arm muscles was different from that of distal hand and forearm muscles even in the same upper extremity, and that the lower extremities showed the same pathways as healthy children. Moreover, in this case, an ipsilateral motor evoked potentials (MEPs) for distal hand muscles increased in amplitude with age, even though the intensity of mirror movements decreased. In the arm muscles, however, it was concluded that the contralateral MEPs increased in amplitude with age.

Keyword

Pyramidal tracts; Evoked potentials; Motor; Synkinesis

MeSH Terms

Arm
Child
Evoked Potentials
Evoked Potentials, Motor
Follow-Up Studies*
Forearm
Hand
Humans
Lower Extremity
Male
Muscles
Pyramidal Tracts
Synkinesis
Transcranial Magnetic Stimulation*
Upper Extremity
Young Adult

Figure

• 

  Fig. 1. Axial color-coded fractional anisotropy map demonstrating well-defined blue color corticospinal tract (CST) at the level of the cerebral cortex (A) and pons (B). The normal connectivity of whole CST was confirmed by diffusion tensor tractography (C).

• 

  Fig. 2. Trend of motor evoked potentials (MEPs) with age, generated by transcranial magnetic stimulation at left motor cortex (A) and right motor cortex (B). For the 1st dorsal interosseous and extensor carpi radialis, ipsilateral MEPs increased in amplitude as the patient grew older. In contrast, the contralateral MEPs increased in amplitude for the biceps brachii and deltoid.

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