Echopraxia (uncontrollable Imitations): Causes And Associated Disorders
We know that imitation is a fundamental part of human development. Humans, like other apes, imitate others during childhood as a form of social learning. However, in some people this imitation does not stop; It becomes a tic that is impossible to avoid and develop a symptom called echopraxia.
The presence of echopraxia or echokinesia may be an indicator of the presence of a neuropsychiatric disorder. Although it may often be obvious, it can manifest itself in more subtle ways that go unnoticed by the naked eye.
Below we briefly describe what ecophenomena are, what we know about their causes and in which disorders they tend to be most characteristic.
Echopraxia is a motor tic that is part of the so-called echophenomena. These symptoms are characterized by imitation. While echolalia consists of the imitation of sounds or words, echopraxia corresponds to the automatic imitation of another person’s actions.
In addition to the imitation of gestures, it can manifest itself in different ways: ecomimia or the imitation of facial expressions, ultrasound or imitation by writing auditory stimuli, echoplasia or the act of drawing the outline of objects or people mentally, in the air or on some surface. Even the imitation of words through sign language, called echolaliophrasia, has been described.
Causes of echopraxia
To understand why people have the tendency to imitate in the first place we must take into account the existence of mirror neurons. These neurons are activated when seeing another perform an action and cause a reaction parallel to that of the person being observed, reflecting the actions of the other. The activation of these neurons does not always lead to movement, since we are capable of inhibiting the motor response.
The imitative center of the brain is located in the inferior frontal gyrus, the inferior parietal lobe, and the upper part of the temporal sulcus. In addition to these, both the prefrontal cortex and premotor areas play a fundamental role in imitating new stimuli. Thus, imitation occurs as a process from the top (perception, encoding of the external stimulus and preparation of the motor action) to the bottom (motor execution).
Traditionally, it is understood that echopraxia occurs because the patient is unable to inhibit motor execution and interrupt the process. However, not all empirical evidence is in agreement. According to recent studies, echopractical tics are highly overlearned motor responses which, once triggered by an external stimulus, are inevitably carried out. It is impossible to interfere with these responses and interrupt them, hence their involuntary and automatic nature.
It is possible that echopraxies, given that they are carried out very frequently and are more consolidated, are more represented in the brain than voluntary movements. In this way, people with echopraxia have a very sensitive and it is impossible for them to control these responses.
Thus, it is not that tics are normal uninterrupted responses, it is that they are much more deep-rooted stimulus-response associations that are triggered by the slightest stimulus.
Ecopractical disorders
There are numerous neuropsychiatric disorders that include echopraxias and echophenomena in general in their clinical presentation. However, there is one that stands out above all. Gilles de la Tourette Disorder (TGD), highly characterized by the presence of tics, echolalia and echopraxias.
Since its first clinical description, the presence of tics is necessary for diagnosis. Patients with PDD show a high rate of tics, coprolalia and echophenomena, being a fundamental pillar of the diagnosis.
In fact, factor analyzes give greater importance to motor tics and echophenomena than to motor hyperactivity or vocal tics, more popularly known.
In PDD, tics occur due to excessive activity in the basal ganglia. It is hypothesized that, because the prefrontal of these patients must be constantly inhibiting tics due to this activity, they end up exhausted and do not interrupt the imitation of the movements of others, showing echopraxias.
Furthermore, the movements they imitate are usually tics that are within their repertoire. This means that they are much more likely to imitate movements that are already much more overlearned in your brain, as we explained a few paragraphs ago, than any other new movement.
2. Schizophrenia
Another disorder where echopraxias may occasionally occur in a more subtle way than in PDD is schizophrenia. The hypothesis is that the schizophrenic patient, due to malfunctioning of the prefrontal area, has trouble controlling inappropriate responses like imitation.
These patients, unlike the rest, are able to control their echopraxies if they are prepared in advance so as not to emit them. For this reason, it is thought that the problem of schizophrenic patients has more to do with executive functions than with learning motor tics.
3. Autism spectrum disorders
In these disorders we frequently find motor extravagances: mannerisms, fluttering, tics, etc. It is to be expected, therefore, that we find the presence of echopraxies. However, Sometimes autistic echopraxias do not function as tics but as behavioral problems.
This means that in people with autism, echopraxia is not established so much by a deficit in executive control or overlearning, but because the individual does not believe that imitation should be repressed or may be socially inappropriate.
4. Other associated disorders
Other disorders where we can find echopractic symptoms include:
Treatment
The treatment of echopraxia will depend on the underlying mechanism that causes it. In cases where neurological dysfunctions prevail, medication will be a cardinal point in the treatment.
However, All forms of tics and echopraxias are susceptible to being treated through behavioral therapy. This is especially important in individuals with autism, where echopraxia is the result of the inability to understand social reality, and in obsessive-compulsive disorder.
