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Mirror movements in Parkinson’s disease: effect of dopaminergic drugs
  1. A J Espay,
  2. F Morgante,
  3. C Gunraj,
  4. R Chen,
  5. A E Lang
  1. Toronto Western Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to:
 Dr Anthony E Lang
 Toronto Western Hospital, Department of Neurology, 399 Bathurst Street, MC 7-413, Toronto, ON, Canada M5T 2S8; lang{at}uhnres.utoronto.ca

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Mirror movements refer to involuntary movements that emulate voluntary activity in contralateral homologous body regions.1 We recently described this phenomenon in the less affected limb in early asymmetric parkinsonism.2 The effects of time and dopaminergic drugs have not been examined. We now report on the re-evaluation of this clinical sign in a subset of patients with clinically definite Parkinson’s disease who were undergoing dopamine replacement therapy, from our original cohort.

METHODS

We recruited 13 treated patients for this longitudinal assessment from the initial cohort of 27 patients2 with suspected mirror movements and recent-onset asymmetric idiopathic Parkinson’s disease, seen at the Movement Disorders Centre, Toronto Western Hospital, between September 2001 and January 2003. At follow–up, all patients had been receiving optimal doses of dopaminergic drugs for many months. Parkinsonian features were combined into axial and lateralised scores using related items of the motor subscale of the Unified Parkinson’s Disease Rating Scale (UPDRS). The asymmetry index was calculated as the absolute difference between the sides divided by the sum of their scores (L−R/[L+R]). A larger asymmetry index indicates greater difference in disease burden between sides and therefore more asymmetry. The patients’ total daily dose of dopaminergic drugs were converted to levodopa equivalents using a published formula. …

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