Long-lasting diagonistic dyspraxia suppressed by rTMS applied to the right motor cortex

Abstract

We describe the case of a 58-year-old patient with complete callosal agenesis, who developed after a stroke a long lasting and distressing diagonistic dyspraxia. We found two original treatments to relieve the patient from his left limb conflicting movements. Reinforcing left arm sensory input minimized dyspraxic movements but was difficult to apply daily and was found unsatisfactory by the patient. As left anarchic, unwished movements of diagonistic dyspraxia have been attributed to the lack of inhibition exerted by supplementary motor area on right motor cortex, we applied sham-controlled rTMS to the right motor cortex. This procedure provided a dramatic suppression of left-hand involuntary movements. To our knowledge, this is the first description of the successful treatment of diagonistic dyspraxia.

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Correspondence to François Sellal.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Video clip #1. Before rTMS. The patient is asked to put some pieces of money in a wallet and to give it back to the examiner. He performed correctly the task with his right hand but, when he tried to give the wallet, the left hand catched it and kept it firmly.

Video clip #2. After rTMS applied to the right motor cortex. Diagonistic dyspraxia has disappeared. The patient is able to give money back to the examiner, without any manual conflict.

Supplementary material 1 (MP4 92284 KB)

Supplementary material 2 (MP4 33902 KB)

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Sellal, F., Cretin, B., Musacchio, M. et al. Long-lasting diagonistic dyspraxia suppressed by rTMS applied to the right motor cortex. J Neurol 266, 631–635 (2019). https://doi.org/10.1007/s00415-018-09178-9

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Keywords

  • Diagnostic dyspraxia
  • Movement disorders
  • Corpus callosum
  • rTMS