Therapeutic benefit of repetitive transcranial magnetic stimulation for severe mirror movements: A case report

Abstract

Congenital mirror movements retard typical hand functions, but no definite therapeutic modality is available to treat such movements. We report an 8-year-old boy with severe mirror movements of both hands. His mirror movements were assessed using the Woods and Teuber grading scale and his fine motor skills were also evaluated by the Purdue Pegboard Test. A 2-week regimen of repetitive transcranial magnetic stimulation produced markedly diminished mirror movement symptoms and increased the fine motor skills of both hands. Two weeks after the completion of the regimen, mirror movement grades had improved from grade 4 to 1 in both hands and the Purdue Pegboard Test results of the right and left hands also improved from 12 to 14 or 13. These improvements were maintained for 1 month after the 2-week repetitive transcranial magnetic stimulation regimen. After 18 months, the mirror movement grade was maintained and the Purdue Pegboard test score had improved to 15 for the right hand while the left hand score was maintained at 13. This occurred without any additional repetitive transcranial magnetic stimulation or other treatment. These findings suggest that repetitive transcranial magnetic stimulation for this patient had a therapeutic and long-term effect on mirror movements.

Keywords: Purdue Pegboard test; clinical practice; cortex suppression; corticospinal tract; grants-supported paper; hand; hand function; mirror movements; neural regeneration; neuroregeneration; neurorehabilitation; transcranial magnetic stimulation.

Figure 1

Results of repetitive transcranial magnetic stimulation for the treatment of mirror movements in an 8-year-old boy. (A) Improvement of mirror movements of both hands assessed by the Woods and Teuber grading scale. (B) Improvement of fine motor skills of both hands assessed by the Purdue Pegboard Test. The Woods and Teuber grading scale ranges from 0–5, with the lower grades indicating more significant improvement of mirror movements. The normative Purdue Pegboard Test scores for 8-year-old normal children suggest that the average score range is 12.07 to 13.90, with higher scores indicating better motor skills.