ECOPRAXIA: CAUSES, TYPES AND ASSOCIATED DISORDERS - NEUROPSYCHOLOGY - 2025

The echopraxia or ecocinesis tic is a complex characterized by imitation or automatic and involuntary repetition of the movements of another. Its name is due to the fact that the person reproduces the movements that are made in front of him like an echo; they can be gestures, blinks or inhalations.

It differs from echolalia in that in the latter there is a reproduction of the words or phrases. The word "echopraxia" comes from the ancient Greek "ἠχώ" or "Ekho" which means sound; and "πρᾶξις" or "praksis", which refers to action or practice.

It is important to know that there is a big difference between repeating actions or phrases voluntarily or reproducing them unconsciously. As for the first case, it is a normal gesture that children often make as a joke. In contrast, in unconscious repetition, it is not intended to imitate or annoy the other person.

Involuntary imitation occurs as an automatic reflex often observed by professionals during the clinical evaluation process. Some patients are fully aware that their motor behavior is strange and uncontrollable. There are even patients who avoid looking at another person who makes exaggerated gestures or abnormal movements to prevent compulsive imitation.

Ecoppraxia is very typical of conditions such as Tourette syndrome, aphasia (language deficits), autism, schizophrenia, catatonia, or epilepsy, among others. Rather, it is considered a symptom of some pathology rather than an isolated disease. Therefore, treatment is usually focused on treating the underlying pathologies.

Mirror neurons, those associated with empathy, are currently thought to play an important role in echopraxia.

Imitative phenomena and echopraxia

Imitation and emulation of actions is essential for social learning. This allows the development of culture and the improvement of behaviors.

Imitative phenomena are not only limited to human beings. They also occur in birds, monkeys, and chimpanzees. The reason for the imitation of actions is to help living beings learn the behaviors necessary to function in life. In addition, imitation contributes to communication and social interaction.

Babies already begin to reproduce the movements of others at birth, gradually decreasing this behavior after 3 years. This occurs due to the development of self-regulatory mechanisms that inhibit imitation.

Although, if this behavior persists or arises in older ages, it may be an indicator of an underlying neuropsychiatric disorder. This is what happens in the case of echopraxia.

Types

Within echopraxia, there are some distinctions according to the type of repetition. For example, ecomymy, when facial expressions are imitated, or ultrasound, if what is reproduced is writing.

Another type is stressful echopraxia, in which the patient repeats actions from fictional programs that he sees on television, potentially harming himself.

Historically there have been numerous classifications of imitative phenomena. According to Ganos, Ogrzal, Schnitzler & Münchau (2012) within the imitation there are different types that must be distinguished:

Imitative learning

In this case, the observer acquires new behaviors through imitation. Young children often imitate their parents and siblings, this is a way to learn new behaviors.

Mimesis or automatic imitation

It occurs when the repeated behavior is based on motor or vocal patterns that we have already learned. An example of this is observed when we adopt the same position of the person next to us without realizing it, or we inevitably "catch" a yawn, something very common in healthy people.

A subcategory within this type are the so-called ecophenomena, which include echopraxia and echolalia. These involve imitative actions that are carried out without explicit awareness, and that are considered pathological.

Why does echopraxia occur? Associated disorders

Echopraxia is a symptom of a major involvement. There are various pathologies that can cause echopraxia, although today the exact mechanism that induces it is not known.

Next, we will see some conditions that can occur with echopraxia.

- Tourette syndrome: it is a neurological disorder in which patients have various tics, repeat movements and sounds involuntarily and uncontrollably.

- Autism Spectrum Disorders: such as Asperger's syndrome or autism, they can show echopraxia.

- Schizophrenia and catatonia: it is estimated that more than 30% of patients with catatonic schizophrenia suffered from echo-reactions (echopraxia and echolalia).

- Ganser syndrome: this condition belongs to dissociative disorders, where the patient can suffer amnesia, run away, and alterations in the state of consciousness; as well as echolalia and echopraxia.

- Alzheimer's disease: it is a type of dementia in which there is a gradual neuronal degeneration. In the advanced stages of the disease, echopraxia and echolalia can be observed.

- Aphasia: a minority of patients with problems producing or understanding language (due to brain disorders), present involuntary behaviors of imitation of words, sounds and movements.

- Brain injuries, tumors or cerebrovascular accidents: mainly those that affect certain parts of the frontal lobe, in the basal ganglia they have been linked to echopraxia. Some patients have been found with this symptom and focal damage in the ventral tegmental area.

This last area of ​​our brain contains the majority of dopaminergic neurons, and these project to the basal ganglia and the cerebral cortex. Damage to this system can induce compulsive echopraxia, in addition to other symptoms, such as speech difficulties.

- Mild mental retardation.

- Major depression: this condition can be accompanied by catatonia and echopraxia.

Mirror neurons and echopraxia

The role of mirror neurons in echopraxia is currently being debated. Mirror neurons are those that allow us to know how others are feeling, that is, they seem to be related to empathy and imitation.

This group of neurons is located in the inferior frontal gyrus and they are activated when we carefully observe another person taking some action. They surely arose to facilitate learning through observation.

Specifically, it seems that when we see another person make a movement (such as running or jumping), the same neural networks are activated in our brain that could be activated in the observed person. That is, the areas of the brain responsible for controlling our movements when running or jumping would be activated, but to a lesser extent than if we actually did it.

Thus, when we observe the movements of another person, our brain reproduces them, but thanks to the inhibition mechanisms they are not executed.

However, if there is some pathology where the inhibition mechanisms are damaged, the observed movements will be reproduced (especially if it is accompanied by high motor excitation). This is what is thought to happen in people with echopraxia.

References

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