Alien Hand Syndrome - Unraveling the Neurological Riddle

Introduction

Alien hand syndrome is a rare medical condition in which one loses control of one's hand, and the hand starts to act independently. An underlying neurological condition moves the hand involuntarily as though it has its mind. Alien hand syndrome, also known as Alien limb syndrome, usually occurs in adults and may sometimes affect one leg. The distinctive feature of alien hand syndrome is that the sufferer complains of regular hand actions that are unintentional, unwanted, and unexpected. The medical condition was first diagnosed in 1909, usually affecting the left or non-dominant hand. The syndrome is known as Dr. Strangelove syndrome, named after a character in a famous film, where a doctor’s right hand repeatedly acts on its own.

What Causes Alien Hand Syndrome?

Alien hand syndrome is usually reported after surgery on the corpus callosum and brain tumors, aneurysms, and degenerative brain diseases. It is caused due to brain damage, disrupting the movement and control of the limb. The syndrome is also seen as a manifestation of a very rare cardioembolic stroke. Alien hand syndrome is also linked to brain surgeries, where it has been sectioned into two. It involves the corpus callosum that allows communication between the two sides. Some of the other brain damages that can lead to Alien hand syndrome include

• Creutzfeldt-Jakob Disease - It is a rare and rapidly progressive neurodegenerative disorder that affects the brain. It is caused by some infectious proteins present in the brain that damages the brain cells and leads to specific brain symptoms.

• Parry-Romberg Syndrome - A rare disorder involving deterioration of the skin and soft tissues of the face. This condition typically affects the skin, underlying fat, muscles, and, in some cases, the facial bones.

• Atypical Parkinson’s Variants - Conditions, such as corticobasal syndrome, in which areas of the brain shrink and degenerate the nerve cells.

• Aneurysms - Enlargement of an artery caused due to weak arterial walls. It is characterized by a localized, unusual bulging or ballooning of the blood vessel walls.

Lesions of Alien hand syndrome can be found affecting different parts of the brain.

• Frontal Lobe Version - It is reported to affect the anterior cingulate cortex and the right hand.

• Callosal Version - It involves the corpus callosum area of the brain.

• Posterior Version - It affects the brain's parietal, posterior lobe, and supplementary motor cortex areas.

People with a specific brain injury are more at risk of developing Alien hand syndrome.

What Are the Features of Alien Hand Syndrome?

One of the most prominent features of Alien hand syndrome is the inability to control the movement of the hand. The syndrome has both psychological and physical effects. The exact symptoms will depend on the version of Alien hand syndrome that has developed and may include

• Involuntary grasping of any object.

• Involuntary groping (search blindly by feeling with hands) of parts of the body or clothes.

• Difficulty in releasing objects that one is holding.

• Involuntary raising of the hand for no reason (levitation).

• Purposeless movement by hands, such as waving.

• To stop recognizing one’s hand due to psychological struggles.

• Uncoordinated movements between the hands. For example, one hand buttons the shirt, and the other opens the just buttoned shirt.

• Having a sense that the hand is foreign and does not belong to them.

However, the affected hand is not weak. Instead, the hand maintains normal strength but may move involuntarily without cognitive control or awareness. In addition, the hand movements are not jerky or spastic but are purposeful and coordinated. Individuals who suffer from alien hand syndrome typically explain that the hand seems to be controlled by someone else. The symptoms, once started, tend to last for about 30 minutes.

How Is Alien Hand Syndrome Diagnosed?

The syndrome is mainly diagnosed by observation and evaluation, lacking a psychiatric component. However, alien hand syndrome's symptoms are often attributed to psychiatric disorders. Therefore, the two criteria for the diagnosis are complaints of a foreign limb and complex, autonomous involuntary motor activity that is not part of an identifiable movement disorder.

• Detailed information regarding the actions and feelings can help to rule out motor-based dysfunction. It may require a complete health history and the medications one takes. The doctor keenly observes the patient's actions, then assesses the frequency and intensity of the episodes.

• A combination of imaging procedures, such as magnetic resonance imaging (MRI), diffusion tensor magnetic resonance imaging (a more specialized technique to map water in the white matter of the brain), and computed tomography (CT) scan, can help to figure out the underlying cause.

How to Treat Alien Hand Syndrome?

There is no available treatment for Alien hand syndrome. It has been reported to last for several years. Treatment for Alien Hand Syndrome can be difficult and varies depending on the underlying reason. The attempt is to address both physical and psychological complications.

• Cognitive Behavioral Therapy - It involves identifying the problem and helping the person to analyze their thoughts, feelings, and behavior and to challenge and reframe their dysfunctional assumptions consciously. It guides the person to think about their condition in a new way.

• Distracting the Limb - People are advised to engage their hands in simple and non-embarrassing activities, such as holding a magazine as they go about the day. It helps to distract the hand from any other involuntary movements.

• Visuospatial Coaching Technique - The strategy helps to help with the perception of the limb about the body. It can help to regain control of the affected limb.

• Prescription Drugs - Use prescription drugs to control nervous system muscles and block random movements. The condition may be managed using Botulinum toxin (a neurotoxin) and neuromuscular blocking agents. Benzodiazepines, such as Alprazolam, Lorazepam, or Lorazepam may be beneficial.

Theoretically, these approaches can slow down the process of restoring voluntary hand control.

Conclusion

Alien hand syndrome presents unusual clinical symptoms, including stroke, damage, and degenerative disease. There is no recommended treatment for Alien hand syndrome, and more research is required. However, the doctor can help manage the symptoms and provide an appropriate treatment plan based on individual needs.