Persistent mirror movement associated with disabling pain and sleep arousal disorder: a case report

Persistent mirror movement (PMM) is a rare pathological condition characterised by involuntary synkinetic movements on one side of the body mirroring the volitional and intentional movements of another side. We present an unusual case of PMM associated with disabling pain, tiredness and headache. 24 years old girl with PMM suffered from pain in mirroring hand during performing fine intended motion by contralateral hand. Pain was so severe that she was not able to write, draw or play the guitar. Intensive physical activity and handiwork was leading her to tiredness and severe headache most alike to tension-type headache. All cases of mirror movements in MEDLINE we have reviewed were painless or at least the authors did not mention painful sensations. In addition the patient in our case report had sleep arousal disorder and excessive daytime sleepiness. PMM may be associated with various disorders but we did not find any case of PMM associated with sleep disorders. We can not affirm that sleep disorders and PMM were pathophysiologically related to each other in our case. But on the other hand relationship between PMM, pain syndrome, headache and neurasthenic complains was obvious. We observed as well that our patient was well tolerated with actions performed by minimal asymmetrical hand movements like typing. But significants asymmetrical movements of hands (working with one hand while keeping another in rest) was not possible because of arising pain.