Abstract
BackgroundThe alien hand syndrome is a striking phenomenon characterized by purposeful and autonomous movements that are not voluntarily initiated. This study aimed to examine neural correlates of this rare neurological disorder in a patient with corticobasal degeneration and alien hand syndrome of the left hand.Methodology/Principal FindingsWe employed functional magnetic resonance imaging to investigate brain responses associated with unwanted movements in a case study. Results revealed that alien hand movements involved a network of brain activations including the primary motor cortex, premotor cortex, precuneus, and right inferior frontal gyrus. Conscious and voluntary movements of the alien hand elicited a similar network of brain responses but lacked an activation of the inferior frontal gyrus. The results demonstrate that alien and unwanted movements may engage similar brain networks than voluntary movements, but also imply different functional contributions of prefrontal areas. Since the inferior frontal gyrus was uniquely activated during alien movements, the results provide further support for a specific role of this brain region in inhibitory control over involuntary motor responses.Conclusions/SignificanceWe discuss the outcome of this study as providing evidence for a distributed neural network associated with unwanted movements in alien hand syndrome, including brain regions known to be related to movement execution and planning as well as areas that have been linked to inhibition control (inferior frontal gyrus) and experience of agency (precuneus).
Highlights
The alien hand syndrome (AHS) is a very rare movement disorder
Imaging data FMRI data of the first experiment revealed that alien movements in patient WH were associated with a network of different brain areas
Stimulation of the left alien hand relative to stimulation of right healthy hand resulted in activation of M1 (36, -38, 50; z = 4.07; p,0.05, family-wise-error (FEW) corrected), left premotor cortex (-56, 4, 42; z = 3.99); precuneus (BA7, 0, -58, 72; z = 6.56), right inferior frontal gyrus (IFG) (50, 30, -6; z = 6.26), and cerebellum (-20, -70, -46; z = 5.88)
Summary
The alien hand syndrome (AHS) is a very rare movement disorder. Patients are aware that the limb is still part of their body, but they report the feeling as if an external agent is controlling the limb. They often describe it in the third person. The alien hand syndrome is a striking phenomenon characterized by purposeful and autonomous movements that are not voluntarily initiated. This study aimed to examine neural correlates of this rare neurological disorder in a patient with corticobasal degeneration and alien hand syndrome of the left hand
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