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Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. Tremor Other Hyperkinet Mov (N Y). 2014;4:241doi: 10.7916/D8VX0F48.
Sarva, H., Deik, A., & Severt, W. L. (2014). Pathophysiology and treatment of alien hand syndrome. Tremor and other hyperkinetic movements (New York, N.Y.), 4241. https://doi.org/10.7916/D8VX0F48
Sarva, Harini, et al. "Pathophysiology and treatment of alien hand syndrome." Tremor and other hyperkinetic movements (New York, N.Y.) vol. 4 (2014): 241. doi: https://doi.org/10.7916/D8VX0F48
Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. Tremor Other Hyperkinet Mov (N Y). 2014 Dec 05;4:241. doi: 10.7916/D8VX0F48. eCollection 2014. PMID: 25506043; PMCID: PMC4261226.
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Tremor Other Hyperkinet Mov (N Y). 2014 Dec 05;4:241. doi: 10.7916/D8VX0F48. eCollection 2014.

Pathophysiology and treatment of alien hand syndrome.

Tremor and other hyperkinetic movements (New York, N.Y.)

Harini Sarva, Andres Deik, William Lawrence Severt

Affiliations

  1. Department of Neurology, Maimonides Medical Center, New York, NY, USA.
  2. Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
  3. Department of Neurology, Maimonides Medical Center, Brooklyn, NY, USA.

PMID: 25506043 PMCID: PMC4261226 DOI: 10.7916/D8VX0F48

Abstract

BACKGROUND: Alien hand syndrome (AHS) is a disorder of involuntary, yet purposeful, hand movements that may be accompanied by agnosia, aphasia, weakness, or sensory loss. We herein review the most reported cases, current understanding of the pathophysiology, and treatments.

METHODS: We performed a PubMed search in July of 2014 using the phrases "alien hand syndrome," "alien hand syndrome pathophysiology," "alien hand syndrome treatment," and "anarchic hand syndrome." The search yielded 141 papers (reviews, case reports, case series, and clinical studies), of which we reviewed 109. Non-English reports without English abstracts were excluded.

RESULTS: Accumulating evidence indicates that there are three AHS variants: frontal, callosal, and posterior. Patients may demonstrate symptoms of multiple types; there is a lack of correlation between phenomenology and neuroimaging findings. Most pathologic and functional imaging studies suggest network disruption causing loss of inhibition as the likely cause. Successful interventions include botulinum toxin injections, clonazepam, visuospatial coaching techniques, distracting the affected hand, and cognitive behavioral therapy.

DISCUSSION: The available literature suggests that overlap between AHS subtypes is common. The evidence for effective treatments remains anecdotal, and, given the rarity of AHS, the possibility of performing randomized, placebo-controlled trials seems unlikely. As with many other interventions for movement disorders, identifying the specific functional impairments caused by AHS may provide the best guidance towards individualized supportive care.

Keywords: Alien hand; alien hand pathophysiology; alien hand treatment; callosal variant; frontal variant; posterior variant

References

  1. Int J Neurosci. 2013 Dec;123(12):892-5 - PubMed
  2. Am J Phys Med Rehabil. 1992 Oct;71(5):297-300 - PubMed
  3. Appl Neuropsychol Adult. 2012;19(1):71-7 - PubMed
  4. Behav Neurol. 2014;2014:873541 - PubMed
  5. J Neurol Sci. 2014 Mar 15;338(1-2):203-6 - PubMed
  6. Arch Phys Med Rehabil. 1998 Jan;79(1):113-4 - PubMed
  7. Surg Neurol. 1991 Apr;35(4):290-3 - PubMed
  8. Neurologist. 2008 Sep;14(5):316-7 - PubMed
  9. Pediatr Neurol. 2010 Apr;42(4):280-2 - PubMed
  10. J Neurol Sci. 2014 Jun 15;341(1-2):153-7 - PubMed
  11. Mov Disord. 2009 Jul 30;24(10):1557-9 - PubMed
  12. Neurology. 2001 Dec 11;57(11):2143-4 - PubMed
  13. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):232-3 - PubMed
  14. Neurol Sci. 2003 Nov;24(4):252-7 - PubMed
  15. J Stroke Cerebrovasc Dis. 2013 Oct;22(7):e240-4 - PubMed
  16. Can J Neurol Sci. 2000 Aug;27(3):192-203 - PubMed
  17. J Neurol Neurosurg Psychiatry. 1988 Feb;51(2):218-22 - PubMed
  18. Neurology. 1995 Apr;45(4):802-8 - PubMed
  19. Neurology. 1992 Jan;42(1):19-24 - PubMed
  20. J Stroke Cerebrovasc Dis. 2009 Jan;18(1):72-3 - PubMed
  21. Brain Res Cogn Brain Res. 2005 Aug;24(3):634-47 - PubMed
  22. J Neurol Neurosurg Psychiatry. 1997 Sep;63(3):404-7 - PubMed
  23. J Clin Neurosci. 2010 Jun;17(6):796-7 - PubMed
  24. Arch Neurol. 1981 Nov;38(11):683-6 - PubMed
  25. Ann Neurol. 2007 Sep;62(3):301-6 - PubMed
  26. Rev Neurol. 2009 May 16-31;48(10):534-9 - PubMed
  27. Neurocase. 2010 Dec;16(6):488-93 - PubMed
  28. J Neurol Neurosurg Psychiatry. 1993 Jul;56(7):788-92 - PubMed
  29. Mov Disord. 2010 Jul 15;25(9):1288-91 - PubMed
  30. Arch Neurol. 1989 Apr;46(4):456-9 - PubMed
  31. AJNR Am J Neuroradiol. 1990 Nov-Dec;11(6):1162-3 - PubMed
  32. Am J Phys Med Rehabil. 2000 Jul-Aug;79(4):395-8 - PubMed
  33. J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):312-5 - PubMed
  34. Cortex. 2013 Sep;49(8):2040-54 - PubMed
  35. Front Integr Neurosci. 2012 Oct 23;6:98 - PubMed
  36. J Neurol Neurosurg Psychiatry. 1995 Jul;59(1):100-1 - PubMed
  37. Neurologist. 2010 Mar;16(2):106-8 - PubMed
  38. J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):246-52 - PubMed
  39. J Neurol Neurosurg Psychiatry. 1992 Sep;55(9):806-10 - PubMed
  40. Arq Neuropsiquiatr. 2001 Sep;59(3-A):521-5 - PubMed
  41. Rev Bras Psiquiatr. 2008 Sep;30(3):290-1 - PubMed
  42. J Neurol Neurosurg Psychiatry. 1995 Jun;58(6):735-7 - PubMed
  43. BMJ Case Rep. 2010 Oct 03;2010:null - PubMed
  44. Neurology. 1993 Dec;43(12):2710-2 - PubMed
  45. Neurocase. 2002;8(6):480-3 - PubMed
  46. Arch Phys Med Rehabil. 2006 May;87(5):728-32 - PubMed
  47. PLoS One. 2010 Dec 13;5(12):e15010 - PubMed
  48. Clin Neurol Neurosurg. 2008 Feb;110(2):190-3 - PubMed
  49. Ann Rehabil Med. 2012 Aug;36(4):556-60 - PubMed
  50. Neuropsychol Rehabil. 2010 Jun;20(3):406-22 - PubMed
  51. Behav Cogn Neurosci Rev. 2003 Dec;2(4):261-77 - PubMed
  52. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):533-6 - PubMed
  53. Arch Neurol. 2004 Feb;61(2):292-4 - PubMed
  54. J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):238-42 - PubMed
  55. Rev Neurol (Paris). 1972 Apr;126(4):257-66 - PubMed
  56. Mov Disord. 2006 Nov;21(11):2018-22 - PubMed
  57. Disabil Rehabil. 2002 Oct 15;24(15):817-8 - PubMed
  58. Parkinsonism Relat Disord. 2011 Feb;17(2):126-7 - PubMed
  59. J Clin Neurol. 2009 Mar;5(1):46-8 - PubMed
  60. J Neurol Neurosurg Psychiatry. 1998 Sep;65(3):366-9 - PubMed
  61. J Neurol Neurosurg Psychiatry. 2002 Oct;73(4):447-9 - PubMed
  62. Cephalalgia. 2007 Dec;27(12):1368-77 - PubMed
  63. Neurorehabil Neural Repair. 2004 Sep;18(3):176-81 - PubMed
  64. Mov Disord. 2005 May;20(5):632-3 - PubMed
  65. J Neurol. 2013 Jul;260(7):1880-8 - PubMed
  66. Neurology. 1986 Aug;36(8):1094-7 - PubMed
  67. Neurol Sci. 2011 Jun;32(3):483-6 - PubMed
  68. Am J Phys Med Rehabil. 1990 Oct;69(5):228-38 - PubMed
  69. Arch Phys Med Rehabil. 1999 Feb;80(2):162-5 - PubMed
  70. J Neuropsychiatry Clin Neurosci. 2013 Fall;25(4):E02 - PubMed
  71. Ann Acad Med Singapore. 1998 Jul;27(4):582-5 - PubMed
  72. Cortex. 1997 Jun;33(2):287-99 - PubMed
  73. Neurosci Biobehav Rev. 2012 Apr;36(4):1107-18 - PubMed
  74. Brain Cogn. 2011 Oct;77(1):138-50 - PubMed
  75. Neurocase. 2010 Aug;16(4):281-5 - PubMed
  76. Neuropsychologia. 1995 Dec;33(12):1703-9 - PubMed
  77. Arch Neurol. 1998 Dec;55(12):1574-6 - PubMed
  78. Epilepsy Behav. 2001 Feb;2(1):61-64 - PubMed
  79. Neuropsychologia. 1991;29(11):1113-27 - PubMed
  80. Clin Neurol Neurosurg. 2009 Sep;111(7):633-5 - PubMed
  81. Curr Biol. 2013 Jan 21;23(2):R57-8 - PubMed
  82. Brain. 1996 Jun;119 ( Pt 3):859-73 - PubMed
  83. J Neurol Sci. 2012 Mar 15;314(1-2):178-80 - PubMed
  84. Mov Disord. 2007 Jan 15;22(2):248-51 - PubMed
  85. J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):103-4 - PubMed
  86. J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):992-3 - PubMed
  87. J Formos Med Assoc. 1996 Apr;95(4):342-6 - PubMed
  88. Disabil Rehabil. 2011;33(17-18):1715-8 - PubMed
  89. BMC Neurol. 2011 Nov 09;11:142 - PubMed
  90. J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):83-5 - PubMed
  91. Neurocase. 2013 Aug;19(4):377-81 - PubMed
  92. Neurocase. 2013;19(1):36-40 - PubMed
  93. Brain. 2014 Jan;137(Pt 1):208-20 - PubMed
  94. J Laryngol Otol. 2012 Jul;126(7):733-6 - PubMed
  95. J Neurol Neurosurg Psychiatry. 1995 Nov;59(5):548-51 - PubMed
  96. Surg Neurol. 2005 Dec;64(6):538-41, discussion 541 - PubMed
  97. Neuropsychologia. 2005;43(1):75-88 - PubMed
  98. Cerebrovasc Dis. 2000 Jan-Feb;10(1):70-2 - PubMed
  99. Epilepsy Behav. 2012 Jan;23 (1):71-3 - PubMed
  100. J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):462-71 - PubMed
  101. Neuroradiology. 2002 Nov;44(11):921-3 - PubMed
  102. Parkinsonism Relat Disord. 2012 Aug;18(7):842-6 - PubMed
  103. Eur Neurol. 1996;36(1):39-42 - PubMed
  104. Neurology. 2006 Dec 26;67(12):E21 - PubMed
  105. Neurocase. 2014 Jun;20(3):307-16 - PubMed

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