So-called echopraxia is characterized by affected individuals compulsively imitating and repeating the movements of others. The manifestation is one of the echomatisms that occur symptomatically in adults as part of mental illnesses such as Tourette syndrome or schizophrenia. In some cases, echopraxia may also occur in dementia patients.
What is echopraxia?
The term echopraxia refers to the pathological imitation of observed movements of others. The complex disorder relates to motor skills and always occurs involuntarily. In some cases, it appears in conjunction with catatonia as so-called echolalia. Here, the affected persons are subject to the compulsion to repeat words heard by others. Echopraxia generally occurs in schizophrenia, Asperger syndrome, autism, oligophrenia, and Tourette syndrome. In some cases, Alzheimer’s patients may also be affected. If only gestures and gestures are imitated, it is called echomimia.
Causes
The movements of other people are directly imitated by those affected by echopraxia. In this case, it is referred to as immediate echopraxia. However, it can also be delayed and repeated permanently. Tourette’s syndrome is a tic disorder in which echopraxia is common. Affected individuals perform involuntary and sudden muscle movements that are often repeated in a stereotyped manner. In most cases, they are also not purposeful. The clinical picture also occurs in other neurological disorders such as schizophrenia. It is usually accompanied by symptoms such as hallucinations, disturbances of the ego, and delusions. However, echopraxia also occurs in global aphasia. This refers to damage to the language center of both hemispheres of the brain, which can be caused, for example, by a tumor, trauma or stroke.
Symptoms, complaints, and signs
Symptoms of echopraxia are characterized by motor tics. They may be associated in some cases with facial twitching, decreased impulse control, compulsive throat clearing, and aggression. These tics vary greatly in severity and are individualized. In particularly severe cases, sufferers can no longer perform voluntary movements. The so-called restless legs syndrome also belongs to the variants of echopraxia. This clinical picture causes involuntary leg movements. Echopraxia also occurs in childhood hyperactivity and attention disorders, various compulsions, self-injury] and many other behavioral disorders. In Tourette syndrome, the first symptoms usually occur between the ages of two and ten. The motor tics often occur at the beginning of the disorder. A large proportion of those affected suffer from complex tics that affect several muscle areas of the body at the same time. During the course of the disease, an echoraxia develops in about 50 percent of cases, which may also spontaneously subside at a later stage. This process is called remission. Echopraxia usually also results in concomitant disorders such as obsessive-compulsive disorder or attention deficit disorder.
Diagnosis
To diagnose the disorder, a detailed history of the affected person is taken. The individual symptoms are then observed and analyzed very closely. This is done over a long period of time in order to be able to classify the severity of the disease. The diagnosis is made by means of a questionnaire and an estimation scale, which are specially provided for the diagnosis of mental and neurological diseases. It is also important to assess the patient with regard to his state of health. The family is also included in this process.
When should one go to the doctor?
Anyone who repeatedly notices motor tics in themselves or others should talk to a doctor or go to the doctor together with the affected person. The compulsion to imitate movements indicates echopraxia, which must be treated by a doctor in any case. It is advisable to seek medical advice at the first signs of this disorder. If symptoms of echopraxia occur after a trauma, stroke or tumor, the responsible physician must be consulted in any case.People who already suffer from a mental illness should go to the responsible therapist immediately with the symptoms mentioned. If echopraxia is recognized and treated at an early stage, the prospects of recovery are generally very good. Accompanying medical treatment, regular visits to a psychologist are indicated. In severe cases, temporary hospitalization is advisable. Since the symptoms of echopraxia can vary greatly, regular check-ups with the doctor are also indicated. If further symptoms develop, a change in medication is necessary.
Treatment and therapy
Echopraxia can be treated with medication in most cases, although symptoms often do not disappear completely. Medications are used to alleviate the appearance. From a psychosocial point of view, the quality of life of those affected can also be considerably improved. The therapy facilitates re-entry into society and contributes to the general well-being of the patients. Since the symptoms of echopraxia vary greatly from individual to individual, a slow increase in the dose of medication is generally recommended. If the therapy responds, the dose can be maintained initially. However, if the symptoms intensify, it is advisable to initiate a change in medication only when the symptoms increase again over a period of several weeks. In this way, a constant change of medication should be prevented. Antipsychotics such as risperidone or aripiprazole are often used to alleviate the symptoms of echopraxia. However, these often lead to unpleasant side effects such as weight fluctuations and fatigue. To counteract this, drugs containing benzamides such as sulpiride or tiapride are used simultaneously. Haloperidol or pimozide, among others, are also used for the classic therapy of echopraxia. Side effects are comparatively frequent when taking these preparations. Furthermore, echopraxia is treated with tic-reducing drugs such as tetrabenazine, topiramate, and tetrahydrocannabinol.
Outlook and prognosis
If echopraxia is diagnosed and treated early, the outlook for recovery is very good. Complaints usually decrease rapidly and well-being slowly improves. After a few months to a year, most patients are symptom-free. A recurrence of the echopraxia symptoms is conceivable, but very unlikely with appropriate medication. If the disease is not treated, it takes a severe course. The symptoms rapidly increase in intensity and significantly reduce the quality of life of the affected person. As a result, psychological complaints often develop as well, which require independent treatment. The typical tics intensify and cause a variety of secondary complaints. In some cases, the behavioral disorders can persist for a lifetime. Patients then require permanent therapeutic care. In the case of Tourette syndrome, complete recovery is unlikely. However, medication and behavioral therapy can greatly reduce symptoms. The motor tics can lead to joint damage and other problems. Still, the outlook for recovery is good, thanks to modern medications such as topiramate and tetrabenazine.
Prevention
A condition such as echopraxia generally cannot be prevented. This is especially true for the so-called Tourette syndrome. This is due to the fact that these clinical pictures have not been defined completely up to the present time. Thus the appropriate basis for prevention is missing. However, it is assumed that the causes are partly genetically determined, but also partly acquired in early childhood. It is also conceivable that there is a connection with various stress factors that have an unfavorable effect on brain development in childhood. In this context, the stress hormone cortisol plays a not insignificant role. But even in adulthood, stressful situations can trigger echopraxia if a genetic predisposition is present at the same time. Therefore, any stress should be avoided as a preventive measure. Various relaxation exercises also help in this regard.
Aftercare
Echopraxia can be treated well if diagnosed early. The prospects for recovery are then very good. To relieve the symptoms of echopraxia, the patient is often prescribed antipsychotics.Therefore, a regular, specialist examination by the neurologist is necessary. If echopraxia is not treated, the symptoms rapidly increase in intensity. They then considerably limit the quality of life. There are only a few possibilities and influencing factors to cope with everyday life with this disease. Therefore, care should be taken to ensure that an echopraxia patient always eats a diet low in fat and rich in vitamins and minerals. Smoking, alcohol and even drug abuse massively aggravate the symptoms and should be avoided if possible. Stress at work or in everyday life can also trigger symptoms of this disease. It is recommended that patients with echopraxia join a self-help organization or discussion group near their home. In the community and in the exchange with people of the same age and, if necessary, their relatives, problems of coping with everyday life of echopraxia sufferers can thus be discussed and debated. The self-help group can become a trusting gathering of affected persons and thus serve the psychological stability of the patient. Psychological complaints (for example, depression) may well thus be avoided, which would otherwise require independent neurological treatment.
What you can do yourself
Echopraxia is a motor disorder in which third persons are imitated compulsively and involuntarily. In some cases, words heard are also repeated as a so-called tic. The syndrome often accompanies Asperger’s, autism, schizophrenia, and Tourette’s. It can also occur as a result of trauma or tumor, which has caused damage to the speech center of both hemispheres of the brain. Self-help for affected persons is based on only a few possibilities to cope with everyday life independently as far as possible. Since the sudden muscle movements and verbal tics vary in severity depending on the case, the therapy plan must also be adhered to in the context of self-help if an individual anamnesis is taken. The tic-reducing drugs can put a lot of stress on the body and cause side effects. Therefore, a low-fat diet rich in vitamins and minerals must be followed. Bad habits such as smoking, alcohol and drug abuse should be avoided. In case of stress, the syndrome may worsen. Regular relaxation exercises and extensive walks in nature, preferably accompanied, are recommended. If the symptom can be traced back to a childhood experience, psychotherapy to cope with the trauma is a helpful measure. If echopraxia is accompanied by severe delusions and hallucinations, assisted living should be initiated regarding the patient’s risk of injury.
