Dr. Strangelove demystified: Disconnection of hand and language dominance explains alien-hand syndrome after corpus callosotomy.
Alien hand
Callosotomy
Hemisphere dominance
Journal
Seizure
ISSN: 1532-2688
Titre abrégé: Seizure
Pays: England
ID NLM: 9306979
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
19
01
2021
revised:
10
02
2021
accepted:
11
02
2021
pubmed:
24
2
2021
medline:
13
7
2021
entrez:
23
2
2021
Statut:
ppublish
Résumé
Alien hand syndrome (AHS) is a disabling condition in which one hand behaves in a way that the person finds "alien". This feeling of alienation is related to the occurrence of movements of the respective hand performed without or against conscious intention. Most information on AHS stems from single case observations in patients with frontal, callosal, or parietal brain damage. Retrospective analysis of distinctive clinical features of three out of 18 epilepsy patients who developed AHS with antagonistic movements of the left hand after corpus callosotomy (CC) (one anterior, two complete) for the control of epileptic seizures, particularly epileptic drop attacks (EDA). Remarkably, these three patients, two men and one woman, displayed atypical language dominance with a bilateral, left more than right hemisphere language representation in intracarotidal amobarbital testing before surgery. The overall additional distinctive feature of the target patients was genuine left-handedness, with writing retrained to right-handedness in two patients. After surgery the left hands became alien. The problem was permanent, despite strategies for compensation. From this observation we suggest that under the conditions of dissociation of language and motor dominance, loss of both intentional control of contralateral action and physiological inhibition of antagonistic movements lead to post-callosotomy alien-hand-like motor phenomena. The dissociation pattern posing this risk seems rare but needs to be considered when evaluating candidates for callosotomy.
Sections du résumé
BACKGROUND
BACKGROUND
Alien hand syndrome (AHS) is a disabling condition in which one hand behaves in a way that the person finds "alien". This feeling of alienation is related to the occurrence of movements of the respective hand performed without or against conscious intention. Most information on AHS stems from single case observations in patients with frontal, callosal, or parietal brain damage.
METHODS
METHODS
Retrospective analysis of distinctive clinical features of three out of 18 epilepsy patients who developed AHS with antagonistic movements of the left hand after corpus callosotomy (CC) (one anterior, two complete) for the control of epileptic seizures, particularly epileptic drop attacks (EDA).
RESULTS
RESULTS
Remarkably, these three patients, two men and one woman, displayed atypical language dominance with a bilateral, left more than right hemisphere language representation in intracarotidal amobarbital testing before surgery. The overall additional distinctive feature of the target patients was genuine left-handedness, with writing retrained to right-handedness in two patients. After surgery the left hands became alien. The problem was permanent, despite strategies for compensation.
CONCLUSION
CONCLUSIONS
From this observation we suggest that under the conditions of dissociation of language and motor dominance, loss of both intentional control of contralateral action and physiological inhibition of antagonistic movements lead to post-callosotomy alien-hand-like motor phenomena. The dissociation pattern posing this risk seems rare but needs to be considered when evaluating candidates for callosotomy.
Identifiants
pubmed: 33621826
pii: S1059-1311(21)00047-9
doi: 10.1016/j.seizure.2021.02.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
147-151Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.