The first case study of its kind documents a girl with mirror movement and rare disorder


If you sit down at the piano, playing different notes with each hand would be the first step in mastering the instrument. But what if both hands are willing to do the same thing? This is the experience of people with a rare condition known as mirror movement, and doctors have now documented a unique case.

Several years ago, researchers in India identified a case of this extremely rare condition in a 13-year-old girl who also has a diagnosis of Turner syndrome, a chromosomal disorder.

Finding the two conditions together is a first for the medical community, raising questions about how – or even if – the two could potentially be linked.

Most little humans take some time to become proficient, but by the age of 10, communication between the two halves of our brains allows us to pinch, poke, shake and move the fingers of each hand independently of each other. one from the other.

For about one in a million children, this development is incomplete, which means that the actions of one hand are repeated simultaneously by the other. Make a victory sign with your left hand and your right will be forced to approach a similar shape.

The underlying cause of this cat-mimicking movement is still largely a matter of speculation, although there is reason to suspect that key nerves in the brain are “interconnected” due to the formation of false synapses between neurons.

In about a third of all cases, mutations in a couple of genes appear to be responsible, impairing the development of the nervous system in such a way that instructions from both sides of the brain are accidentally passed on to both sides of the body.

As for the rest of the recorded cases, clearly there is still a lot to learn about the brain and its development.

One place we can look for more clues is in other symptoms and behaviors exhibited by those affected by this condition and ask if there is a deeper relationship.

For example, individuals who also have cerebral palsy will show degrees of mirror movement. Parkinson’s disease is another condition that can come with this form of so-called synkinesia, especially if it affects more of one side of the brain than the other.

Having ruptures or no connection between the hemispheres – a bridge of neurons called the corpus callosum – can also coincide with behavior. It is in many of these cases that a genetic link has been discovered.

Kallmann’s syndrome is a condition caused by a lack of certain hormones, which gives rise to characteristics such as lack of smell and delayed puberty. And, sometimes, mirror movements.

Turner syndrome is also a condition that affects a body’s ability to coordinate hormonal responses.

Prior to this case, no one had registered a person having the chromosomal abnormality and would have experienced mirror movements as well.

The syndrome is caused by the absence of a second X chromosome, leaving those with the disorder with only one X to do the work. The consequences can be spread throughout the body, ranging from heart defects to a reduced height and a failure in the development of the ovaries.

In the case of this particular young subject, there were some slight physical abnormalities and an absence of secondary sexual characteristics. An echocardiogram of his heart revealed an aortic valve with two instead of the usual three flaps, but otherwise they all looked healthy.

Aside from bad school work, her speech and other neurological signs were all that was expected of a girl her age. However, as you can see below, given the task of counting to five on his left hand, his right hand couldn’t help but join.

An MRI revealed no surprises, and without the resources to take a closer look at the physiology of her brain, medical staff at the Sri Ramachandra Institute of Higher Education and Research had to assume it was “just one of those things.”

Since mirror movements are incredibly rare, and Turner syndrome only affects one in 2,000 women, it’s hard to tell if it’s a coincidence or if there’s some kind of connection that could tell us more about either condition. Medical science is often a matter of recording new discoveries such as these and waiting patiently to see if future discoveries add to the increment of evidence.

As for the young woman, now 19, we are happy to say that the subject of this unusual case study seems to be doing otherwise.

“Considering her age, she was started with increasing doses of estrogen followed by progesterone therapy,” the endocrinologists write.

This case study was published in BMJ case reports.


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