Ecopraxia (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 an impossible tic to avoid and develop a symptom called echopraxia .
The presence of echopraxia or ecokinesia can be an indicator of the presence of a neuropsychiatric disorder . Although it can often be evident, it can manifest itself in more subtle ways that go unnoticed by the naked eye.
Next, we briefly describe what echophenomena are, what we know about their causes and in which disorders they tend to be most characteristic.
- Related article: "Echolalia: what it is, causes and related disorders"
What exactly is echopraxia?
Ecopraxia is a motor tic that is part of the so-called eco-phenomena. 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, ecoplasia or the act of drawing the outline of objects or people mentally, in the air or on some surface. Even imitation of words has been described through sign language, called echolaliofrasia.
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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 by seeing another perform an action and cause a reaction parallel to that of the observed, reflecting the actions of the other. The activation of these neurons does not always lead to movement, because we are able to inhibit the motor response.
The imitative brain center 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 the premotor areas play a fundamental role in the imitation of new stimuli. Thus, imitation occurs as a process from above (perception, codification of the external stimulus and preparation of the motor action) downwards (motor execution).
Traditionally, it is understood that echopraxia occurs because the patient is unable to inhibit motor performance and interrupt the process. However, not all the empirical evidence agrees. According to recent studies, Ecopractical tics are highly overestimated motor responses that, 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 the ecopraxias, since 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 association between stimulus and tic and they find it impossible to control these answers .
Thus, it is not that the tics are normal uninterrupted responses, it is that they are much more ingrained stimulus-response associations that are triggered by the slightest stimulus.
There are numerous neuropsychiatric disorders that include ecopraxias and ecophenomena in general in their clinical presentation. However, there is one that stands out above all. The Gilles de la Tourette Disorder (TGD), highly characterized by the presence of tics, echolalia and echopraxias.
1. Disorder of Gilles de la Tourette
From 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 eco-phenomena than to motor hyperactivity or vocal tics, more popularly known.
In the TGD, 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, ends exhausted and does not interrupt the imitation of the movements of others, showing ecopraxias.
In addition, the movements that they imitate tend to be tics that are within their repertoire. This means that they are much more likely to imitate movements that are already very overlearned in your brain, as we expose a few paragraphs ago, than any other new movement.
- Related article: "Tourette syndrome: what is it and how does it manifest?"
Another disorder where ectoplasias occasionally occur in a more subtle way than in the PDD is schizophrenia. The hypothesis is that the schizophrenic patient, due to the malfunction of the prefrontal area, have problems controlling inappropriate responses like imitation.
These patients, unlike the rest, are able to control their ecopraxias if they are prepared in advance so as not to issue them. Because of this, it is thought that the problem of schizophrenic patients has more to do with executive functions than with the learning of motor tics.
3. Autism spectrum disorders
In these disorders we often find motor extravagances: mannerisms, flutters, tics, etc. It is expected, therefore, that we find the presence of ecopraxias. But nevertheless, Sometimes autistic echopraxias do not work as tics , but as behavioral problems.
This means that in people with autism the echopraxia is not established so much by a lack of executive control or overlearning, but because the individual does not believe that imitation should be repressed or it may be socially inappropriate.
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4. Other associated disorders
Other disorders where we can find ecopractic symptoms include:
- Neurocognitive disorders (dementias)
- Transcortical aphasia
- Autoimmune disorders
- Obsessive-compulsive disorder with tics
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.
But nevertheless, 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 an inability to understand social reality, and in obsessive-compulsive disorder.