Seeing the phantom: a functional magnetic resonance imaging study of a supernumerary phantom limb.

OBJECTIVE: Supernumerary phantom limb (SPL) is a rare neurological manifestation where patients with a severe stroke-induced sensorimotor deficit experience the illusory presence of an extra limb that duplicates a real one. The illusion is most often experienced as a somesthetic phantom, but rarer SPLs may be intentionally triggered or seen. Here, we report the case of a left visual, tactile, and intentional SPL caused by right subcortical damage in a nondeluded woman. METHODS: Using functional magnetic resonance imaging, we investigated the multimodal nature of this phantom, which the patient claimed to be able see, use, and move intentionally. The patient participated in a series of sensorimotor and motor imagery tasks involving the right, the left plegic, and the SPL's hand. RESULTS: Right premotor and motor regions were engaged when she imagined that she was scratching her left cheek with her left plegic hand, whereas when she performed the same task with the SPL, additional left middle occipital areas were recruited. Moreover, comparison of responses induced by left cheek (subjectively feasible) versus right cheek scratching (reportedly unfeasible movement) with the SPL demonstrated significant activation in right somesthetic areas. INTERPRETATION: These findings demonstrate that intentional movements of a seen and felt SPL activate premotor and motor areas together with visual and sensory cortex, confirming its multimodal dimension and the reliability of the patient's verbal reports. This observation, interpreted for cortical deafferentation/disconnection caused by subcortical brain damage, constitutes a new but theoretically predictable entity among disorders of bodily awareness.

Neural mechanisms of embodiment: asomatognosia due to premotor cortex damage.

BACKGROUND: Patients with asomatognosia generally describe parts of their body as missing or disappeared from corporeal awareness. This disturbance is generally attributed to damage in the right posterior parietal cortex. However, recent neuroimaging and electrophysiological studies suggest that corporeal awareness and embodiment of body parts are instead linked to the premotor cortex of both hemispheres. PATIENT: We describe a patient with asomatognosia of her left arm due to damage in the right premotor and motor cortices. The patient's pathological embodiment for her left arm was associated with mild left somatosensory loss, mild frontal dysfunction, and a behavioral deficit in the mental imagery of human arms. CONCLUSION: Asomatognosia may also be associated with damage to the right premotor cortex.

Preattentive interference between touch and audition: a case study on multisensory alloesthesia.

Alloesthesia is a rare clinical condition that corresponds to a spatial disorder of stimulus localization, in which patients experience a given stimulus on the side opposite to the side of stimulation. Whereas it has been mostly described for unisensory stimulations, evidence of multisensory alloesthesia is only anecdotal. Here, we investigated a case of multisensory auditory-tactile alloesthesia. Our data suggest that auditory-tactile integration and multisensory alloesthesia not only depend on attentional mechanisms, but also on somatotopic preattentive mechanisms.

Linking out-of-body experience and self processing to mental own-body imagery at the temporoparietal junction.

The spatial unity of self and body is challenged by various philosophical considerations and several phenomena, perhaps most notoriously the "out-of-body experience" (OBE) during which one's visual perspective and one's self are experienced to have departed from their habitual position within one's body. Although researchers started examining isolated aspects of the self, the neurocognitive processes of OBEs have not been investigated experimentally to further our understanding of the self. With the use of evoked potential mapping, we show the selective activation of the temporoparietal junction (TPJ) at 330-400 ms after stimulus onset when healthy volunteers imagined themselves in the position and visual perspective that generally are reported by people experiencing spontaneous OBEs. Interference with the TPJ by transcranial magnetic stimulation (TMS) at this time impaired mental transformation of one's own body in healthy volunteers relative to TMS over a control site. No such TMS effect was observed for imagined spatial transformations of external objects, suggesting the selective implication of the TPJ in mental imagery of one's own body. Finally, in an epileptic patient with OBEs originating from the TPJ, we show partial activation of the seizure focus during mental transformations of her body and visual perspective mimicking her OBE perceptions. These results suggest that the TPJ is a crucial structure for the conscious experience of the normal self, mediating spatial unity of self and body, and also suggest that impaired processing at the TPJ may lead to pathological selves such as OBEs.

Levodopa reverses gait asymmetries related to anhedonia and magical ideation.

Animals and men turn preferentially away from the hemisphere with the more active dopamine (DA) system. Consistent with the idea of a right-hemispheric hyperdopaminergia in schizophrenia, a leftsided turning bias was described for unmedicated psychotic patients. We investigated the modulating role of DA and schizophrenia-like thought on whole-body turns in a controlled double-blind study. The number of veers to either side when walking blindfolded straight ahead (20 meter) was assessed in 40 healthy righthanded men (20 men received levodopa, the remaining participants placebo). Side preferences were analyzed in terms of individuals' positive (Magical Ideation, MI) and negative (Physical Anhedonia, PhysAn) schizotypal features. In the placebo group, increasing MI scores were related to increasing left-sided veering and increasing PhysAn scores were related to increasing right-sided veering. In the levodopa group, this relationship between preferred veering side and type of schizotypy was reversed. The finding in the placebo group suggests an association between MI and a relative right-hemispheric hyperdopaminergia. Unexpectedly, levodopa did not enhance this veering bias, but reversed it, suggesting that psychosis-protective mechanisms exist in the healthy positive "schizotypic" brain. Also unexpectedly, levodopa made "anhedonics" veer like "magics" after placebo, suggesting that DA agonists suppress negative schizotypal symptoms.

Cortical motion deafness.

The extent to which the auditory system, like the visual system, processes spatial stimulus characteristics such as location and motion in separate specialized neuronal modules or in one homogeneously distributed network is unresolved. Here we present a patient with a selective deficit for the perception and discrimination of auditory motion following resection of the right anterior temporal lobe and the right posterior superior temporal gyrus (STG). Analysis of stimulus identity and location within the auditory scene remained intact. In addition, intracranial auditory evoked potentials, recorded preoperatively, revealed motion-specific responses selectively over the resected right posterior STG, and electrical cortical stimulation of this region was experienced by the patient as incoming moving sounds. Collectively, these data present a patient with cortical motion deafness, providing evidence that cortical processing of auditory motion is performed in a specialized module within the posterior STG.

Nonstereotyped responding in positive schizotypy after a single dose of levodopa.

Stereotyped behavior and left-sided orientation biases, associated with the dopamine (DA) system, were observed in populations of the schizophrenia spectrum disorders. We investigated whether heightened DA concentrations influence both side biases and stereotyped responding in a visuo-motor computer task, in which 90, 180, and 270 degrees rotated objects had to be brought into a target position. To account for the role of the schizophrenia spectrum, task performance was also analyzed as a function of healthy participants' high or low magical ideation (MI), a positive schizotypal feature. The first 36 participants (20 women) remained substance free. In a second sample, 20 men received levodopa and 20 men a placebo in a double-blind procedure. Results showed that high MI scorers responded more stereotyped than low MI scorers, without being specifically biased towards the left side. Rotation preferences toward one or the other side made high MI scorers less flexible for objects efficiently to be rotated into the opposite direction. This inflexibility may reflect impaired left hemisphere functioning. Unexpectedly, in the levodopa group, high MI scorers performed superior to low MI scorers. Since DA actions appear to follow an inverted U-shape function, the 'low' performing high MI scorers profited from the enhanced DA availability. Our observation in the levodopa group points to a dissociation between schizotypy and schizophrenia: while cognitive improvement in schizophrenia can occur after treatment with atypical neuroleptic agents, in our positive schizotypal participants a DA agonist resulted in improved task performance. This dissociation may point to protective neurochemical mechanisms preventing healthy schizotypes from developing full-blown psychotic symptoms.

[Kinesiologic analysis of gait and abnormal movements]. / Analyse cinésiologique de la marche et des mouvements anormaux.

Gait disorders, postural instability and movement disorders, such as tremor, chorea or dystonia, are common complaints in day-to-day neurological practice. These conditions are quite difficult to appreciate objectively when relying on clinical observation only, yet a correct assessment of their phenomenology and an accurate measurement of their main characteristics are required to address the questions of both the underlying diagnosis and the functional impairment they may generate. By contrast, kinesiological analyses allow qualitative and quantitative studies of gait, posture and movements and may lead to specific therapeutic interventions. kinesiological analyses, which requires a high-technology laboratory conducted by a trained staff, is based on the sequential or simultaneous use of various and complementary measurement methods, whose choice is problem-oriented. Hence, the use of specific observational analysis, three-dimensional kinematic recordings, poly-electromyography and electro goniometry for the analysis of gait, the use of force plate for the analysis of postural stability and the use of electromyography and multiaxial accelerometers or gyroscopes for the analysis of movement disorders. In the present article, we review the particular features of these measurement tools and the clinical usefulness of their routine use illustrated by case reports.

Dynamics of brain activation during an explicit word and image recognition task: an electrophysiological study.

Recent brain imaging studies suggest that semantic processing of words and images may share a common neural network, although modality-specific activation can also be observed. Other studies using event-related potentials (ERPs) report that brain responses to words and images may already differ at approximately 150 ms following stimulus presentation. The question thus remains, which differences are due to perceptual categorization processes and which differences are due to the semantic ones? Using ERP recordings and spatio-temporal source localization analysis, we investigated the dynamics of brain activation during a recognition task. The stimuli consisted of a randomized set of verbal (words vs. non-words) and pictorial items (line drawings of objects vs. scrambled drawings). After each stimulus, subjects had to decide whether it corresponds to a recognizable word or objects. ERP map series were first analyzed in terms of segments of quasi-stable map topography using a cluster analysis. This showed that verbal and pictorial stimuli elicited different field patterns in two time segments between approximately 190-400 ms. Before and after this period, map patterns were similar between verbal and pictorial conditions indicating that the same brain structures were engaged during the early and late steps of processing. Source localization analysis of map segments corresponding to the P100 and the N150 components first showed activation of posterior bilateral regions and then of left temporo-posterior areas. During the period differentiating conditions, other patterns of activation, involving mainly left anterior and posterior regions for words and bilateral posterior regions for images, were observed. These findings suggest that, while sharing an initial common network, recognition of verbal and pictorial stimuli subsequently engage different brain regions during time periods generally allocated to the semantic processing of stimuli.

Motor control and cerebral hemispheric specialization in highly qualified judo wrestlers.

With the purpose of investigating motor and cognitive lateralization profiles associated with long-term motor training, we investigated differences in hemispheric specialization between proficient judo sportsmen and controls through the assessment of a number of handedness and footedness items including postural preferences as well as dichotic listening and lateralized visual field tests. Our data show that: (1) the different handedness and footedness items did differently relate to each other within the athlete and control groups as revealed by a principle component analysis (PCA); (2) stand side correlated differently to these motor profile factors in athletes and controls; (3) athletes preferred more frequently to perform certain movements with the left hand than controls, although overall right-handed; (4) this was especially true for athletes which proved to be most proficient/skilled; and (5) in a lateralized verbal listening task and a lateralized visual field task athletes revealed enhanced right-hemispheric involvement relative to controls. Our results suggest that during motor and postural skill acquisitions (long-term judo training) lateral preferences are modified, probably due to neuroplasticity. Moreover, the present findings support the multidimensional view of handedness by Steenhuis and Bryden [Cortex 25 (1989) 289] and the notion of a right-hemispheric "praxis system" involved in skilled action routines within peripersonal space [Brain and Cognition 23 (1993) 181].