Carlos A Morra’s reply to Carlos R. Hojaij’s comment
Carlos Morra and Ernst Franzek Psychopathological Symptoms Motor Perseveration
I agree with Carlos Hojaij’s first observation regarding the use of the term “motor.” We psychiatrists are frequent users of neologisms to clarify psychopathological symptoms or signs instead of using the already existing, correct terms. My native language is Spanish and the term "motor" is an accepted term in Spanish (Motor/Motríz), but I have seen that in English it is not accepted by some. Yet, Frank Fish included in his Clinical Psychopharmacology a whole chapter on “Motor disorders.” Included in the chapter is the term "perseveration" (Hamilton 1976).
"Motor perseveration" can also be referred to as “Palipraxia.” In case of “palipraxia," the patient persists in doing the same motor activity that was relevant in a certain moment, but not later on, i.e., a patient shakes the doctor´s hand and repeats the same movement several times, immediately after he finished the appropriate one. Palipraxia is defined as a tendency to repeat previously executed movements (Cutting 1997) after they become unnecessary to the circumstance.
The presence of motor perseveration can be established in two different ways. In one, the spontaneous presence of motor perseveration is established by observing the patient during his/her regular activities to see if he/she persists doing a certain task, The other one is to elicit the presence of the sign by generating some voluntary activities and watching for unnecessary repetitions.
I agree with you that Falret used the term “Stereotypies” for the first time, but the original description of the term comes from Ghislain several years before. The first descriptions of the term included all the forms of repetition, i.e., motor, affective, language, etc. In addition to perseverations, “palilalia”; “palipraxia”; “palithymia”; some of the echoing phenomena, like “echopraxia”; and “echolalia” were also included. Later on, all of these terms were separated from “stereotypies”and the use of the term was restricted to the presence of reiterative words, phrases, and motor activities that are repeated relentlessly without any meaning or objective (Porot 1960). The main characteristics of stereotypes listed by Porot (1960) are: stability, duration, identity, pointlessness and inadequacy to the circumstances.
The definition we presented originally, by mistake, for motor perseveration is the definition of “echopraxia,” an externally triggered echoing phenomenon that is usually listed as one of many “environmental dependency” phenomena, i.e., utilization behaviour, echolalia, echothymia, echokinesis, etc.
Some of the diagnoses related to the presence of motor perseverations are presented in the following list:
Aphasia (Albert and Sandson 1986)
Frontal Lesions (Annoni 1998)
Brain Lesions (Right Hemisphere) (Annoni 1998)
Parkinson´s Disease (Stoffers 2001)
Alzheimer´s Disease (Allison 1966)
Pick´s Disease (Allison 1966)
Arteriosclerotic Dementia (Allison 1966)
Vascular Lesions (Allison 1966)
Brain Tumors (Allison 1966)
Brain Abscess (Allison 1966)
Traumatic Brain disease (Vaughan 1997)
Cerebral Edema (Allison 1966)
Huntington´s Chorea (Redondo-Vergé 2001)
Frontotemporal Dementias (Mendez and Shapira 2008)
Brain Hypoxia (Allison 1966)
Brain Damage due to Anoxia (i.e., Estrangement) (Matthey 1996)
Carbon Monoxide Intoxication (Allison 1966)
Progressive Multifocal Leukoencephalopathy (Takase et. al. 2005)
Progressive Supranuclear Palsy (Nitrini 1987)
Cardiovascular Disorders (Allison 1966)
Internal Bleeding (Allison 1966)
Alcohol and Drugs intoxications (Allison 1966)
Hypoglycemia (Allison 1966)
Liver Encephalopathies (Allison 1966)
Geriatric patients with medical conditions (Ruchinskas and Giuliano 2003)
Schizophrenias (Gargiulo 2003)
Catatonia (Crider 1997)
Obsessive Compulsive Disorders (Moritz et. al. 2009)
Gilles de la Tourette Syndrome (Cavanna et. al. 2008)
Cri du Chat Syndrome (Cornish and Pigram 1996)
I would like to thank Doctor Hojaij for detecting and bringing to our attention our mistake.
Albert ML, Sandson J. Perseveration in aphasia. Cortex 1986; 22 : 103-15.
Allison RS. Perseveration as a sign of diffuse and focal brain damage. I. Br Med J. 1966; 2 (5521): 1027-32
Annoni G, Pegna A, Michel C, Estade M, Landis T. Motor perseverations: a function of the side and the site of a cerebral lesion. Eur Neurol 1998; 40: 84-90.
Cavanna AE, Robertson MM, Critchley HD. Catatonic signs in Gilles de la Tourette syndrome. Cogn Behav Neurol 2008; 21: 34-37.
Cornish KM, Pigram J. Developmental and behavioural characteristics of cri du chat syndrome. Arch Dis Child 1996;75: 448-50.
Crider A. Perseveration in schizophrenia. Schizophr Bull 1997; 23(1: 63-74.
Cutting J. Principles of psychopathology. Two worlds-two minds- two hemispheres. Oxford: Oxford Medical Publications; 1997, p. 422.
Gargiulo PA. Experimental approaches to perceptual dysfunction in schizophrenia. Rev Neurol 2003; 37: 545-51.
Hamilton M. Fish´s clinical psychopathology. 2nd Ed. Bristol: Wright; 1976, pp. 101-2.
Matthey S. Modification of perseverative behaviour in an adult with anoxic brain damage. Brain 1996; 10: 219-27.
Mendez MF, Shapira JS. The spectrum of recurrent thoughts and behaviors in frontotemporal dementia. CNS Spectr 2008; 13: 202-8.
Moritz S, Hottenrott B, Randjbar S, Klinge R, Von Eckstaedt FV, Lincoln TM, Jelinek L. Perseveration and not strategic deficits underlie delayed alternation impairment in obsessive-compulsive disorder (OCD). Psychiatry Res 2009; 170: 66-9.
Nitrini R. Elementary motor perseveration in early diagnosis of progressive supranuclear palsy. Arq Neuropsiquiatr 1987; 45: 29-32.
Redondo-Vergé L. Cognitive deterioration in Huntington disease. Rev Neurol 2001; 32: 82-5.
Porot A.Manuel alphabetique de psychiatrie, clinique et therapeutique. 10ª Ed. Paris: Presses universitaires de France; 1950, . p. 662.
Ruchinskas RA, Giuliano AJ. Motor perseveration in geriatric medical patients. Arch Clin Neuropsychol 2003; 18: 455-61.
Stoffers D, Berendse HW, Deijen JB, Wolters EC. Motor perseveration is an early sign of Parkinson's disease. Neurology 2001; 57: 2111-3.
Takase K, Ohyagi Y, Furuya H, Nagashima K, Taniwaki T, Kira J. A case of progressive multifocal leukoencephalopathy presenting white matter MRI lesions extending over the cerebral cortex and a marked decrease in cerebral blood flow on SPECT, and associated with HTLV-I infection. Rinsho Shinkeigaku 2005; 45: 426-30.
Vaughan N, Agner D, Clinchot DM. Perseveration and wandering as a predictor variable after brain injury. Brain Inj 1997; 11: 815-9.
October 19, 2017