Ipsilateral synkinesia involves the supplementary motor area.

The supplementary motor area coordinates movements. Synkinesia is a rare disorder in which an involuntary movement occurs coordinated with a voluntary movement. Here, we test the hypothesis that the supplementary motor area is involved in involuntary coordination of movement. We collected functional magnetic resonance imaging (fMRI) data from two patients with ipsilateral hand-foot synkinesia and two control participants while they performed rhythmic tasks. In synkinesia patients, both the supplementary motor area and the foot motor cortex were significantly activated during the hand motor task. This pattern was not seen in controls. Our findings suggest that the supplementary motor area plays a central role in involuntary coordination observed in synkinesia, and provides insight into how the supplementary motor area orchestrates movements.