Congenital mirror movements: Phenotypes associated with DCC and RAD51 mutations

• Two phenotypes of CMM were identified using accelerometer gloves and analysis.
• “Actual” mirroring was observed in a family with a RAD51 mutation.
• “Fractionated” mirroring was observed in a family with a DCC mutation.
• Mutations in three additional families with CMM remain unidentified.
• Our glove analysis detected mirroring in cases where visual observation could not.

Congenital mirror movements (CMM) is a disorder characterized by unintentional mirroring in homologous motor systems of voluntary movements on the opposite side, usually affecting the distal upper extremities. Genetic analyses have revealed involvement of three genes (DCC, RAD51, and DNAL4). We sought to distinguish whether different phenotypes of CMM exist, and if so, whether they might map to different causative genes. We studied 14 individuals across five families with dominantly-inherited CMM. We used accelerometer gloves to analyse the fine detail of index finger tapping movements, and applied standard genetic methodology to analyse DNA samples. Two forms of mirroring were distinguished: ‘actual’ in which the mirroring followed precisely the movements of the voluntary hand, and ‘fractionated’ in which the mirroring was saccadic. We found that actual mirroring was characteristic of individuals in a family with a RAD51 mutation, and fractionated more characteristic of a family with a DCC mutation. These findings are suggestive of specific genotype–phenotype correlations in CMM. Three heterozygous individuals (one RAD51; two DCC) showed no apparent mirroring on visual inspection, although mirroring was detectable with the accelerometer gloves. Thus, subclinical mirroring may be present even when undetectable on clinical observation.