Search

Anna Sedda,1,2 Gabriella Bottini1,21Department of Behavioral and Brain Sciences, University of Pavia, Pavia, 2Cognitive Neuropsychology Laboratory, Niguarda Ca’ Granda Hospital, Milan, ItalyAbstract: This review summarizes the available studies of a rare condition in which ­individuals seek the amputation of a healthy limb or desire to be paraplegic. Since 1977, case reports and group studies have been produced, trying to understand the cause of this unusual desire. The main etiological hypotheses are presented, from the psychological/psychiatric to the most recent neurologic explanation. The paradigms adopted and the clinical features are compared across studies and analyzed in detail. Finally, future directions and ethical implications are discussed. A proposal is made to adopt a multidisciplinary approach that comprises state-of-the-art technologies and a variety of theoretical models, including both body representation and psychological and sexual components.Keywords: BIID, limb amputation, somatoparaphrenia, body representation, body ownership

Copyright of Die MKG-Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research with brain damaged humans provides evidence that conscious tactile perception is generated not through a specific sensory section of the brain but rather through multiple sensory representations from the primary somatosensory cortex. Recovery of conscious awareness of touch after cerebral damage especially after the vestibular system has been stimulated provides support for shared perceptions of signals because the body is able to redistribute the neural system to compensate for damaged areas.

A damaged area of the brain may result in a sensory defect on the opposite side of the body. The single-sided anesthesia which can result, called hemianesthesia, is most commonly the result of defective processing of sensory information within the brain. However, hemianesthesia may also result from a condition called hemineglect as well. In this condition, the anesthesia may result not from a defect in sensory processing, but rather in a defect in the attention of the patient, who may ignore not only one side of the world, but one side of his own body, as well. It is believed that the right hemisphere is in charge of the greater portion of attention processes, and therefore most neglect patients suffer neglect of the right side of the world as a result of a lesion, most often caused by a stroke, in their right cerebral hemispheres. From the standpoint of the researcher attempting to learn more about the relation between symptoms and brain damage, it is difficult to distinguish between a patient who does not feel a sensation and one who feels it but cannot pay attention to it. The authors report the case of a 51-year-old man who suffered a right hemisphere stroke and developed left hemispatial neglect, which refers to neglect of the left side of the space around him and differs from left hemineglect, in which the patient also may neglect the left side of his body. This patient had left-sided weakness, and although he was aware of the weakness and of his condition, the patient could not feel light touch or pinprick on or sense the position of his left side. Ice-water was poured in the patient's left ear to provide stimulation to the vestibular system. When this was done, the patient performed normally on a test to detect his left hemispatial neglect, and was able to sense 27 of 40 stimuli on his left hand, when previously he could not detect any. Thirty minutes after the ice-water treatment, the patient had returned to his pretest symptoms of hemispatial neglect and left hemianesthesia. The results show that in this patient the sensory processing mechanisms were intact, as revealed by the cold-water treatment. That the patient normally cannot feel on his left side is most likely due to a failure to attend to stimuli arriving from the left side rather than an inability to perceive them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disruption of motor control in the alien hand syndrome might result from a dissociation between intentions and sensory information. We hypothesized that voluntary motor control in this condition could improve by restoring the congruency between motor intentions and visual feedback. The present study shows that, in one patient with right alien hand syndrome, the use of a mirror box paradigm improved motor speed. We speculate that the visual feedback provided by the mirror increases the sense of congruence between intention and sensory feedback, leading to motor improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Video-games are becoming a common tool to guide patients through rehabilitation because of their power of motivating and engaging their users. Video-games may also be integrated into an infrastructure that allows patients, discharged from the hospital, to continue intensive rehabilitation at home under remote monitoring by the hospital itself, as suggested by the recently funded Rewire project. OBJECTIVE: Goal of this work is to describe a novel low cost platform, based on video-games, targeted to neglect rehabilitation. METHODS: The patient is guided to explore his neglected hemispace by a set of specifically designed games that ask him to reach targets, with an increasing level of difficulties. Visual and auditory cues helped the patient in the task and are progressively removed. A controlled randomization of scenarios, targets and distractors, a balanced reward system and music played in the background, all contribute to make rehabilitation more attractive, thus enabling intensive prolonged treatment. RESULTS: Results from our first patient, who underwent rehabilitation for half an hour, for five days a week for one month, showed on one side a very positive attitude of the patient towards the platform for the whole period, on the other side a significant improvement was obtained. Importantly, this amelioration was confirmed at a follow up evaluation five months after the last rehabilitation session and generalized to everyday life activities. CONCLUSIONS: Such a system could well be integrated into a home based rehabilitation system. [ABSTRACT FROM AUTHOR]

We describe the case of a patient with late onset fronto-temporal dementia (FTD), who presented with typi-cal personality changes, but also perseverative and confabulatory behaviors while performing the Rey-Osterrieth Complex Figure Test. We hypothesize that the progressive atrophy of orbitobasal, medial, and dorsolateral frontal cortices may give rise to both confabulations and perseverations in the non-verbal domain. In agreement with previous studies, reporting atypical profiles, this case report underlines the clinical heterogeneity of FTD. [ABSTRACT FROM AUTHOR]

In 2000 Baddeley proposed the existence of a new component of working memory, the episodic buffer, which should contribute to the on-line maintenance of integrated memory traces. The author assumed that this component should be critical for immediate recall of a short story that exceeds the capacity of the phonological store. Accordingly, patients with Alzheimer's dementia (AD) should suffer of a deficit of the episodic buffer when immediate recall of a short story is impossible. On the other hand, the episodic buffer should be somewhat preserved in such patients when some IR can occur (Baddeley and Wilson, 2002). We adopted this logic for a voxel-based morphometry study. We compared the distribution of grey-matter density of two such groups of AD patients with and of a group of age-matched controls. We found that both AD groups had a significant atrophy of the left mid-hippocampus; on the other hand, the anterior part of the hippocampus was significantly more atrophic in patients who were also impaired on the immediate prose recall task. Six out of ten patients with no immediate recall were spared at "central executive" tasks. Taken together our findings suggest that the left anterior hippocampus contributes to the episodic buffer of the revised working memory model. We also suggest that the episodic buffer is somewhat independent from the central executive component of working memory. [ABSTRACT FROM AUTHOR]

Objective: To explore the hypothesis that dopaminergic circuits play a part in the premotor components of the unilateral neglect syndrome, the effects of acute dopaminergic stimulation in patients with neglect were studied.Methods: Two tasks were evaluated before and after subcutaneous administration of apomorphine and placebo: a circle crossing test and a test of target exploration (a modified version of the bell test), performed both in perceptual (counting) and in perceptual-motor (pointing) conditions.Subjects: Four patients with left neglect.Results: After dopaminergic stimulation, a significant improvement was found compared with placebo administration and baseline evaluation, in the performance of the two tests. Three of the patients had a more marked improvement in the perceptual-motor condition (pointing) of the task than the perceptual condition (counting).Conclusions: The findings suggest that dopaminergic neuronal networks may mediate, in different ways, both perceptive and premotor components of the unilateral neglect syndrome. [ABSTRACT FROM AUTHOR]

A patient with an ischaemic lesion involving the right frontal lobe and basal ganglia showed left spatial hemineglect in visuomotor exploratory tasks, requiring the use of the right unaffected hand. Her performance was, however, entirely preserved, with no evidence of neglect, when she was required to identify targets among distractors in both the left and right halves of space, and in the Wundt-Jastrow illusion test. The latter tasks do not require any arm movement in extrapersonal space. In this patient spatial hemineglect may be explained in terms of defective organisation of movements towards the left half-space (directional hypokinesia). The frontal lesion of the patient may be the neural correlate of this selective disorder. This pattern of impairment may be contrasted with the typical deficit found in patients with right brain damage with perceptual neglect. One case had a defective performance both in visuomotor and in purely perceptual tasks. [ABSTRACT FROM AUTHOR]

Purpose: Virtual Reality (VR) platforms gained a lot of attention in the rehabilitation field due to their ability to engage patients and the opportunity they offer to use real world scenarios. As neglect is characterized by an impairment in exploring space that greatly affects daily living, VR could be a powerful tool compared to classical paper and pencil tasks and computer training. Nevertheless, available platforms are costly and obstructive. Here we describe a low cost platform for neglect rehabilitation, that using consumer equipments allows the patient to train at home in an intensive fashion. Method: We tested the platform on IB, a chronic neglect patient, who did not benefit from classical rehabilitation. Results: Our results show that IB improved both in terms of neglect and attention. Importantly, these ameliorations lasted at a follow up evaluation 5 months after the last treatment session and generalized to everyday life activities. Conclusions: VR platforms built using equipment technology and following theoretical principles on brain functioning may induce greater ameliorations in visuo-spatial deficits than classical paradigms possibly thanks to the real world scenarios in association with the "visual feedback" of the patient's own body operating in the virtual environment. [ABSTRACT FROM AUTHOR]

The incidence of somatosensory, visual half-field and motor deficits contralateral to a hemispheric lesion in a continuous series of 154 left brain damaged and 144 right brain damaged stroke patients were investigated. These contralateral disorders were more frequent after lesions of the right hemisphere. This difference cannot be attributed to a bias in patients' selection. It is suggested that left spatial neglect is the factor underlying this hemispheric difference. [ABSTRACT FROM AUTHOR]

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non‐epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age‐related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive‐behavioural therapy as a first‐line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non‐epileptic seizure management should be multidisciplinary. High‐quality long‐term studies are needed to standardize PNES management. Click here to view the accompanying paper in this volume. [ABSTRACT FROM AUTHOR]