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Abstract
Majority of movements in everyday situations are complex and involve volition, planning of the movement and selection of the motor programme, all occurring before movement execution. Higher order motor disorders may be defined as abnormal motor behaviours resulting from disruption of any of the cortical processes that precede execution of the motor act. They are common in patients with neurodegenerative disorders, psychiatric diseases and structural brain lesions. These abnormal behaviours may be overlooked in the clinic, unless specifically evoked by the examiner. We discuss clinical and pathophysiological aspects of higher order motor disorders including: (1) disorders of disinhibition, such as grasp reflex and grasping behaviour, utilisation and imitation behaviour, motor preservations and paratonia; (2) disorders of motor intention such as motor neglect and motor impersistence; (3) alien limb syndrome; and (4) motor overflow phenomena, such as mirror movements and synkinesias. A video illustration of each phenomenon is provided. We place the findings from recent neurophysiological studies within the framework of theories of motor control to provide better insight into pathophysiology of different disorders.
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Affiliation(s)
- Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
| | - Kailash P Bhatia
- Institute of Neurology, University College London, 7 Queen Square, London, WC1N 3BG, UK
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Kim HJ, Kim D, Won DH, Chin J, Lee KH, Seo SW, Heilman KM, Na DL. Callosal Motor Impersistence: A Novel Disconnection Syndrome. Cogn Behav Neurol 2017; 30:68-72. [PMID: 28632524 DOI: 10.1097/WNN.0000000000000125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Motor impersistence, an inability to sustain a certain position or movement, is a motor-intentional disorder, caused more often by right than left hemisphere lesions. Since the right hemisphere is dominant for mediating motor persistence, callosal lesions that disconnect the left hemisphere from the right may induce impersistence of the right upper and lower limbs. After an undiagnosed left callosal infarction, a 65-year-old right-handed man suddenly developed a transient loss of volitional movement of his left leg. Five days after onset, he was admitted to our hospital with signs of callosal disconnection: left-hand agraphia and apraxia, left-hand tactile anomia, failures on cross-replication of hand postures, and intermanual conflict. He had neither weakness nor ataxia of his upper or lower extremities, but when asked to keep his arms or legs extended he could not maintain his right arm and leg in the extended position, suggesting motor impersistence in his dominant limbs. When we examined him 3 months after onset, the motor impersistence had disappeared. In conclusion, motor impersistence of dominant limbs can result from isolated callosal injury that disconnects the left hemisphere from the right hemisphere's frontal-subcortical networks.
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Shoraka AR, Otzel DM, M Zilli E, Finney GR, Doty L, Falchook AD, Heilman KM. Effects of aging on action-intentional programming. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2017; 25:244-258. [PMID: 28264637 DOI: 10.1080/13825585.2017.1287854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Action-intentional programs control "when" we initiate, inhibit, continue, and stop motor actions. The purpose of this study was to learn if there are changes in the action-intentional system with healthy aging, and if these changes are asymmetrical (right versus left upper limb) or related to impaired interhemispheric communication. METHODS We administered tests of action-intention to 41 middle-aged and older adults (61.9 ± 12.3 years). RESULTS Regression analyses revealed that older age predicted a decrement in performance for tests of crossed motor response inhibition as well as slower motor initiation with the left hand. CONCLUSION Changes in action-intention with aging appear to be related to alterations of interhemispheric communication and/or age-related right hemisphere dysfunction; however, further research is needed to identify the mechanisms for age-related changes in the brain networks that mediate action-intention.
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Affiliation(s)
- Ali R Shoraka
- b Geriatric Research Education and Clinical Center of the Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA.,c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA
| | - Dana M Otzel
- b Geriatric Research Education and Clinical Center of the Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA
| | - Eduardo M Zilli
- c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA
| | - Glen R Finney
- c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA
| | - Leilani Doty
- c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA.,d Florida Department of Elder Affairs , Alzheimer's Disease Initiative, University of Florida Cognitive and Memory Disorder Clinics , Gainesville , FL , USA.,e National Institutes of Health/National Institute of Aging, 1Florida ADRC (Alzheimer's Disease Research Center) , Gainesville , FL , USA
| | - Adam D Falchook
- a Brain Rehabilitation Research Center of the Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA.,c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA
| | - Kenneth M Heilman
- a Brain Rehabilitation Research Center of the Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA.,b Geriatric Research Education and Clinical Center of the Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA.,c Department of Neurology and Center for Neuropsychological Studies , University of Florida , Gainesville , FL , USA.,d Florida Department of Elder Affairs , Alzheimer's Disease Initiative, University of Florida Cognitive and Memory Disorder Clinics , Gainesville , FL , USA
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Abstract
Callosal disconnection signs are closely related to asymmetric hemispheric specialization of cognitive functions. Although extinction is more commonly associated with the right parietotemporal lesion, it may occur following lesions of the corpus callosum. After an infarction involving the left splenium, a 58-year-old right-handed man had no disconnection symptoms that had been reported earlier, but showed visual extinction with left or right visual hemifield dominant stimuli. Our results suggest that dominance specific visual extinction might be another disconnection sign associated with splenial lesion.
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Affiliation(s)
- J I Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, South Korea
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