Ecoppraxia (uncontrollable imitations): causes and 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; becomes a tic that is impossible to avoid and develop a symptom called echopraxia.

The presence of echopraxia or echokinesis may be indicative of a neuropsychiatric disorder. Although many times it may be obvious, it can manifest itself in more subtle ways that go unnoticed by the naked eye.

Below we briefly describe what ecofenomena are, what we know about their causes, and in which disorders they tend to be more 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 ecophenomena. These symptoms are characterized by imitation. While echolalia consists of the imitation of sounds or words, echopraxia corresponds to the automatic imitation of someone else'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 the imitation through the writing of auditory stimuli, ecoplasia or the act of mentally drawing the outline of objects or people, in the air or in some surface. Imitation of words through sign language, called echolaliofrasia, has even been described.

• You may be interested: "The 18 types of mental illness"

Causes of echopraxia

To understand why people tend to imitate in the first place we must take into account the existence of mirror neurons. These neurons are activated when they see 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, as 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 superior part of the temporal sulcus. In addition to these, both the prefrontal cortex as the premotor areas play a fundamental role in the imitation of new stimuli. Thus, imitation occurs as a process from above (perception, encoding of the external stimulus and preparation of motor action) downwards (motor execution).

Traditionally, echopraxia is understood to occur because the patient is unable to inhibit motor performance and interrupt the process. However, not all the empirical evidence agrees. According to recent studies, eco-practical tics are highly overlearned motor responses which, once triggered by an external stimulus, are inevitably carried out. It is impossible to interfere with and interrupt these responses, hence their involuntary and automatic nature.

Ecopraxias, since they occur very frequently and are more consolidated, may be more represented in the brain than voluntary movements. In this way, people with echopraxia have a very sensitive stimulus-tic association and it is impossible for them to control these responses.

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.

Echopractic 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's Disorder (PDD), highly characterized by the presence of tics, echolalia and echopraxia.

1. Gilles de la Tourette's disorder

From its first clinical description, the presence of tics is necessary for its diagnosis. Patients with PDD show a high rate of tics, coprolalia and ecofenomena, being a fundamental pillar of diagnosis.

In fact, factor analyzes attach greater importance to motor tics and ecofenomena than 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 ends up exhausted and does not interrupt the imitation of the movements of others, showing echopraxias.

In addition, the movements that they imitate are usually tics that are within their repertoire. This means that they are much more likely to mimic movements that are already much overlearned in your brain, as we discussed a few paragraphs ago, than any other new movement.

• Related article: "Tourette syndrome: what is it and how does it manifest?"

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 the malfunction of the prefrontal area, have trouble controlling inappropriate responses like imitation.

These patients, unlike the rest, are capable of controlling their echopraxias if they are prepared in advance 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, flapping, tics, etc. It is expected, therefore, that we find the presence of echopraxias. However, sometimes autistic echopraxies do not function as ticsbut as behavioral problems.

This means that in people with autism, echopraxia is not established so much by a deficit of executive control or overlearning, but because the individual does not believe that imitation should be repressed or it may be socially inappropriate.

• You may be interested: "The 4 types of Autism and their characteristics"

4. Other associated disorders

Other disorders where we can find echopractic symptoms include:

• Neurocognitive disorders (dementias)
• Transcortical aphasia
• Epilepsy
• Autoimmune disorders
• Obsessive-compulsive disorder with tics

Treatment

Treatment for echopraxia will depend on the underlying mechanism that causes it. In cases where neurological dysfunctions prevail, medication will be a cardinal point in treatment.

However, all forms of tics and echopraxias are susceptible to being treated through behavior 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.