Dr. Strangelove demystified: Disconnection of hand and language dominance explains alien-hand syndrome after corpus callosotomy

Helmstaedter, Christoph; Solymosi, L.; Kurthen, Martin; Momjian, Shahan; Schaller, Karl

doi:10.1016/j.seizure.2021.02.013

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…Symptoms of disconnection syndrome vary, but can include changes to visuospatial, language, sensory, and motor function 38,39 . The incidence of this phenomenon is fairly low and often transient 14,40 . Given the significant limitation and/or inability to participate in baseline or postoperative neurocognitive testing in many of these patients with poor cognition and functional status, there is often difficulty in detecting clinical signs of disconnection syndrome among these patients.…”

Section: Discussionmentioning

confidence: 99%

“…38,39 The incidence of this phenomenon is fairly low and often transient. 14,40 Given the significant limitation and/or inability to participate in baseline or postoperative neurocognitive testing in many of these patients with poor cognition and functional status, there is often difficulty in detecting clinical signs of disconnection syndrome among these patients. Although acknowledging this limitation in detection, we did not observe any clinical signs of disconnection syndrome in our patient group.…”

Section: Anterior and Complete Corpus Callosotomymentioning

confidence: 99%

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Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy

et al. 2023

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ObjectiveCorpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less‐invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real‐time magnetic resonance imaging (MRI) thermometry. This study aims to (1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, (2) compare anterior and complete CC, and (3) review LITT as a surgical alternative to open craniotomy for CC.MethodsThis retrospective cohort study included 103 patients <21 years of age with at least 1 year follow‐up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior vs complete and open versus LITT surgical approaches were assessed.ResultsCC was the most common surgical disconnection (65%, n = 67) followed by anterior two‐thirds (35%, n = 36), with a portion proceeding to posterior completion (28%, n = 10). The overall surgical complication rate was 6% (n = 6/103). Open craniotomy was the most common approach (87%, n = 90), with LITT used increasingly in recent years (13%, n = 13). Compared to open, LITT had shorter hospital stay (3 days [interquartile range (IQR) 2–5] vs 5 days [IQR 3–7]; p < .05). Modified Engel class I, II, III, and IV outcomes at last follow‐up were 19.8% (n = 17/86), 19.8% (n = 17/86), 40.2% (n = 35/86), and 19.8% (n = 17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n = 52/69).SignificanceNo significant differences in seizure outcome between patients who underwent only anterior CC and complete CC were observed. LITT is a less‐invasive surgical alternative to open craniotomy for CC, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.

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Section: Discussionmentioning

confidence: 99%

Section: Anterior and Complete Corpus Callosotomymentioning

confidence: 99%

Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy

et al. 2023

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“…The corpus callosum may be involved as well. The most common etiology is a stroke of the anterior communicating artery territory [30]. In the frontal variant, the supplementary motor area, cingulate cortex, and prefrontal cortex have been reported to be involved.…”

Section: Anterior Phenotypementioning

confidence: 99%

“…The corpus callosum is involved in communication between hemispheres and inhibition of impulses. Disconnection syndromes are frequent when a callosal lesion occurs, especially after callesectomies due to epilepsy surgery [30]. The alien hand or ALP is another type of disconnection syndrome that occurs when the corpus callosum is compromised [30].…”

Section: Callosal Phenotypementioning

confidence: 99%

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The Alien Limb Phenomenon in Creutzfeldt-Jakob Disease: A Systematic Review of Case Reports

Sen¹,

Moncayo²,

Kelley³

et al. 2022

Cureus

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Alien limb phenomenon (ALP) is a clinical finding seen in numerous neurological disorders, including Creutzfeldt-Jakob disease (CJD). We aimed to conduct a systematic review to update advances in understanding the classification and pathophysiology of ALP in CJD. We used PubMed advanced-strategy searches and only included full-text observational studies and case reports conducted on humans and written in English. We used the PRISMA protocol for this systematic review and the Methodological Quality of Case Reports tool to assess the bias encountered in each study. After applying the inclusion/exclusion criteria, 10 case reports were reviewed. Two independent reviewers analyzed data and confirmed the phenotype of each case of the alien limb in CJD separately. Overall, the most prevalent ALP phenotype presenting in patients with CJD was the posterior phenotype, usually in the early stages of the disease. Our findings corroborate previous research in demonstrating the pathophysiology behind ALP in CJD. We suggest physicians suspect CJD whenever patients present with ALP as the initial symptom.

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Pediatric Neurostimulation and Practice Evolution

Ghatan

2024

Neurosurgery Clinics of North America

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Dr. Strangelove demystified: Disconnection of hand and language dominance explains alien-hand syndrome after corpus callosotomy

Cited by 5 publications

References 23 publications

Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy

Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy

The Alien Limb Phenomenon in Creutzfeldt-Jakob Disease: A Systematic Review of Case Reports

Pediatric Neurostimulation and Practice Evolution

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