Supernumerary Phantom Limb Research Articles

Effect of transcranial direct current stimulation on supernumerary phantom limb pain in spinal cord injured patient: A case report

BACKGROUND Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report effect of transcranial direct current stimulation (tDCS) on SPL pain in a patient with cervical cord injury. CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury (C6/C5, motor level; C5/C5, sensory level; AIS-A) approximately three months ago. After a period of 2 wk, we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA. Following that treatment, the patient experienced a decrease of SPL pain intensity and frequency, which lasted for 1 week after the end of treatment. CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.

Supernumerary Phantom Pain: From Mechanisms To Treatment

The article is devoted to the supernumerary phantom pain. It is described as pain in a supernumerary phantom limb. This is a very rare phenomenon with only sporadic and brief descriptions in the literature. However, this syndrome brings great suffering to the patient not only due to the feeling of pain, but also due to the complexity of its description and the difficulty of understanding by the doctor. For simplicity, patients draw a supernumerary limb and mark the location of pain on it. The pathogenesis of supernumerary phantom pain is not completely clear. Therefore, the description of each case is important for clinical practice. The article attempts to summarize the available information about the etiology, pathogenesis, methods of diagnosis and therapy of this syndrome.

Delusional Supernumerary Phantom Limb Following Right Putaminal Hemorrhage

Delusional Supernumerary Phantom Limb Following Right Putaminal Hemorrhage

A supernumerary phantom limb with voluntary movement and changes in shape in the right upper limb after left putamen hemorrhage

A supernumerary phantom limb with voluntary movement and changes in shape in the right upper limb after left putamen hemorrhage

The long sixth finger illusion: The representation of the supernumerary finger is not a copy and can be felt with varying lengths

We can have a distorted perception of our body, instantly induced with multisensory illusions, anaesthesia or Virtual Reality, and recent studies show we can also feel extra body parts. Newport and colleagues (Newport et al., 2016) created an illusion that induces the feeling of having a sixth finger on one's hand, for a brief moment. By changing the paradigm with a double back and forth stroking, we were able to extend the duration of this illusion (Cadete & Longo, 2020), which can reflect an endured representation of a supernumerary finger. This innovation allowed us to test one specific distortion in the supernumerary finger: length. Patients with supernumerary phantom limb syndrome feel like they have an extra limb, as if one of their limbs was duplicated (Staub et al., 2006), resembling the same size and shape of the existing one. It is unclear from existing studies whether a supernumerary limb is represented as a copy of the existing limb, or if it is represented independently, with its own features. We therefore aimed to investigate whether the properties of the supernumerary sixth finger could be altered, independently of the actual little finger. Hence, we tested whether we can embody a sixth finger with double the size of the average little finger, and half its size. Participants reported feeling a long and a short sixth finger, and gave visual judgements on the felt length of the supernumerary finger, that matched the condition length. Overall, the results show that the supernumerary sixth finger is not a mere copy of the little finger but is represented independently, with distinct features from the existing finger. Moreover, the representation of the supernumerary finger is flexible, allowing the embodiment of a long or a short sixth finger.

Experimental Inducibility of Supernumerary Phantom Limbs: A Series of Virtual Reality Experiments

Supernumerary phantom limb (SPL) is a rare neuropsychiatric syndrome, under which patients perceive more limbs than they anatomically possess (e.g. two instead of only one right arm). Remarkably, the concurrent limb percepts can thereby differ in respect to their primarily-experienced modality, for instance, that one kinesthetic and one moving limb is experienced. Although SPLs are well documented after various neuropsychiatric conditions, their neurocognitive pathomechanisms still remain elusive. Therefore, an experimental paradigm by which such aberrant body misperceptions could be transiently induced and systematically investigated in healthy participants would be helpful. Inspired by the virtual hand illusion, we developed a virtual supernumerary limb illusion (SLI) version, in which two embodiable virtual hands are presented to the participant via a head-mounted display. One virtual hand is thereby presented medially and the other laterally aside the participant’s hidden real hand. Using this general setup, we examined the inducibility of a SLI in three consecutive experiments: Experiment 1 explored by which induction type (visuotactile congruency, visuothermal congruency and visuomotor congruency) SLI experiences can be induced most robustly, Experiment 2 whether SLIs can be induced by a combination of these induction types, and Experiment 3 how visuoproprioceptive congruency influences the inducibility of a SLI. Sense of ownership towards the virtual hands was systematically assessed by means of experience sampling and by an implicit electrodermal embodiment measure. Results reveal a robust effect of stronger sense of ownership towards the medially- than laterally-presented virtual hand, while only a subgroup of participants (on average, across experiments: ~25%) reported concomitant sense of ownership towards both virtual hands (i.e. a full-blown SLI experience). The highest SLI responder rate (~63%) was observed for the combined application of visuotactile and visuothermal congruency, whereas a combined application of visuothermal and visuoproprioceptive congruency induced the lowest SLI responder rate (~4%). In conclusion, our study demonstrates that although under specific experimental conditions, a majority of participants can be made to experience a SLI, under most conditions sense of ownership is only experienced towards one virtual hand. This indicates that multiple type-identical limb percepts are avoided to be co-instantiated by our brain, wherever possible.

A case of supernumerary phantom limb induced by intention to move the left plegic limb

A case of supernumerary phantom limb induced by intention to move the left plegic limb

Birth and death of a phantom.

Patients with supernumerary phantom limb report experiencing an additional limb duplicating its physical counterpart, usually following a stroke with sensorimotor disturbances. Here, we report a short‐lasting case of a right upper supernumerary phantom limb with unusual visuomotor features in a healthy participant during a pure Jacksonian motor seizure unexpectedly induced by continuous Theta‐Burst Stimulation over the left primary motor cortex. Electromyographic correlates of the event followed the phenomenological pattern of sudden appearance and brutal dissolution of the phantom, adding credit to the hypothesis that supernumerary phantom limb results from a dynamic resolution of conflictual multimodal information.

Phantom Sensations, Supernumerary Phantom Limbs and Apotemnophilia: Three Body Representation Disorders.

Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric diseases. We present the main characteristics of 3 examples of body representation disorders: phantom sensations, supernumerary phantom limb, and apotemnophilia. The dysfunction of anatomical circuits that regulate body representation can sometimes have paradoxical features. In the case of phantom sensations, the patient feels the painful subjective sensation of the existence of the lost part of the body after amputation, surgery or trauma. In case of apotemnophilia, now named body integrity identity disorder, the subject wishes for the disappearance of the existing and normal limb, which can occasionally lead to self-amputation. More rarely, a brain-damaged patient with 4 existing limbs can report the existence of a supernumerary phantom limb.

Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

BackgroundSupernumerary phantom limb (SPL) is a rare neurologic phenomenon, in which a patient misperceives an extra limb in addition to the original set of limbs. We report a case of SPL in a patient with a right basal ganglia hemorrhage and review the previous literature about this peculiar phenomenon.Case presentationTwo days after the event of a right basal ganglia hemorrhage, a 78-year-old male reported a phantom arm protruding from his left shoulder. He could not see or touch the phantom arm but he felt the presence of an addition arm lateral to his paretic arm. Pain or sensory discomfort were absent in either the paretic arm or the phantom arm. He stated that he could intentionally move the phantom arm independent of his paretic arm. The examination showed that the passive movement of his paretic arm did not elicit any movement of his phantom arm. We diagnosed the SPL as a complication of the hypertensive basal ganglia hemorrhage and treated him with anti-hypertensive medications. His phantom arm persisted for 3 weeks, and it gradually faded away.ConclusionSPL had been reported as a rare complication of various types of cerebral lesions. Right hemispheric lesions were most frequently associated with the SPL. Considering the intentional movement of the phantom arm, we deduced that the SPL might result from the impairment of the sensory feedback system for both internal body image and motor movement.

Cortico–thalamic disconnection in a patient with supernumerary phantom limb

Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse. Here, we tested this hypothesis by studying an extremely rare patient with chronic SPL, still present 3years after a vascular stroke affecting cortical and subcortical right-hemisphere structures. Anatomical analysis included an advanced in vivo reconstruction of white matter tracts using diffusion-based spherical deconvolution. This reconstruction demonstrated a massive and relatively selective disconnection between anatomically preserved SMA/PMC and the thalamus. Our results provide strong anatomical support for the hypothesis that cortico-thalamic loops involving motor-related circuits are crucial to integrate sensorimotor processing with bodily self-awareness.

A case of pontine hemorrhage with controllable supernumerary phantom limb prolonged for more than four years

<b>A case of pontine hemorrhage with controllable supernumerary phantom limb prolonged for more than four years</b>

(330) Supernumerary phantom limb pain in a patient with neurosarcoidosis and peripheral neuropathy

(330) Supernumerary phantom limb pain in a patient with neurosarcoidosis and peripheral neuropathy

The effect of virtual visual feedback on supernumerary phantom limb pain in a patient with high cervical cord injury: a single-case design study

We characterized the effect of virtual visual feedback (VVF) on supernumerary phantom limb pain (SPLP) in a patient with high cervical cord injury. The subject was a 22-year-old man diagnosed with complete spinal cord injury (level C2) approximately 5 years ago. We applied the ABA′B′ single-case design and set phases B and B′ as intervention phases for comparison. SPLP significantly improved in comparison of phase A with phase B and phase A with phase B′. We suggest that VVF reduces SPLP and the effect lasts after VVF.

A case of ambidextrous woman who have the somatoparaphrenia, supernumerary phantom limb, anosognosia, and right unilateral neglect due to left thalamic hemorrhage

矯正歴のある両手利きの左視床出血患者において, 身体パラフレニアや病態失認を含む, 多彩な劣位半球症状を認め, かつ脳卒中後では極めて報告の少ない余剰幻肢も合併した症例を経験した。患者は 83 歳女性で, 左視床出血後に, 重度の右片麻痺と感覚の脱失を認めた。覚醒は良好で全般的認知機能の低下はほとんどなく, 失語はごく軽度であった。一方, 右半側空間無視や病態失認などの劣位半球症状に加え, 身体パラフレニアと余剰幻肢を認めた。身体パラフレニアと余剰幻肢は発症後約 2 ヵ月で消失したが, 病態失認は残存した。このような症状が認められた機序として, 両手利きという背景から推測される, 右半球機能の大半と書字を中心とした言語野の一部が左半球に偏在するという脳機能側性化の変化が示唆された。また, 病巣は, 視床～内包後脚に限局していたにもかかわらず, SPECT にて広範な左大脳半球の血流低下を認めたことから, 視床から側頭葉・頭頂葉などに投射する線維を介した diaschisis が症状発現に寄与している可能性も考えられた。

中枢性疼痛を伴う余剰幻肢を呈した橋出血の1 例

中枢性疼痛を伴う余剰幻肢を呈した橋出血の1 例

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Supernumerary phantom limb as a rare symptom of epileptic seizures—case report and literature review

Supernumerary phantom limbs, that is, the awareness of an illusory extra limb is a fascinating neurologic symptom that has been described in a number of neurologic diseases including stroke, spinal injury, and epilepsy. Herein we report a case of a 70-year-old male patient with new-onset focal seizures with left-sided supernumerary phantom arm and leg as the only seizure manifestation. Ictal single-photon emission computed tomography (SPECT) revealed a hyperperfusion in the right temporoparietal junction and allowed localization of the seizure-onset zone. This report is accompanied by a discussion of phenomenology and terminology in the context of existing literature.

The Author Response: The Supernumerary Phantom Limb and Phantom Limb Pain in Stroke: Localization and Management Concerns

The supernumerary phantom limb is the problem of perception of body scheme (1), and phantom limb pain is one type of central pain, defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system (brain, brainstem, and spinal cord) (2). Central pain is a neurological disorder that is rather common although difficult to treat, causing unrelenting suffering and disability (3). Diagnosis of central pain that may occur following stroke is complicated by cognitive and speech limitations as well as by depression, anxiety and sleep disturbances. Localized brain lesions causing central pain and their management have not been established clearly. Kiefer et al. (4) reported that the phantom limb pain is difficult to treat compared to conventional pain, and repetitive transcranial magnetic stimulation (rTMS) have shown to respond to drug resistant neurogenic pain (3, 5). The mechanism of cortical stimulation for the relief of pain is based on the excitability modification of neuronal activity intimately involved in the neural circuits responsible for perception and pain processing. Lefaucheur et al. (5) studied whether neurogenic pain relief by rTMS depended on the origin or the site of pain. The most favorable conditions were trigeminal nerve lesion, facial pain, and absence of severe sensory loss within the painful zone. The worst conditions were brainstem stroke, limb pain, and severe sensory loss. Basbaum et al. (6) described various descending modulatory pathways in the brainstem acting on pain transmission. Patients with brainstem stroke could have damage on these structures, leading to the inefficacy of corticothalamic descending control triggered by rTMS. The patients in our case report had the supernumerary phantom limb and phantom limb pain after brainstem stroke (7). We chose multimodal sensory neurocognitive rehabilitation and anticonvulsants (pregabalin) instead of rTMS (1). The purported age difference between poststroke patients, who developed central poststroke pain and those who did not, is a subject of some debate in the literature. Anderson et al. (8) found no disparity in age between the patients that went on to develop central poststroke pain (n = 87) versus those that did not (n = 120). Bowsher (9) found a significant difference in age of stroke onset between 130 central pain patients (median age 57 yr) and the whole stroke population (median age 75 yr). No studies on the relationship of demographic characteristics and phantom limb pain have been published. Both patients in our case report are middle-aged, highly educated, and have median socioeconomic status. In addition, the patients did not have psychotic symptoms (hallucination, delusion), therefore psychiatric consultation about supernumerary phantom limb was thought to be unnecessary. Subsequent larger and randomized studies are needed to examine the relationship between demographic characteristics (age, sex, education level), personality characteristics and central pain including phantom limb pain. We really appreciate the comments by Dr. Das, and further evaluation is needed for the brain localization of body scheme and the management of central pain.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in Two Patients with Pontine Hemorrhage

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.