WHAT IS ALIEN HAND SYNDROME

ALIEN HAND SYNDROME (AHS)

Alien Hand Syndrome is also referred to as Dr. Strangelove Syndrome, Strangelovian hand or Anarchic hand. It is a rare neurological condition in which one hand is not under the control of the mind. The person loses control of the hand, and acts as if it has a mind of its own which starts to act independently. It is an observable, involuntary motor activity where the limb feels foreign to the owner. Sometimes it also affects the leg, but it isn’t as common. It can affect children but is usually diagnosed in adults. It involves multiple sensory signals and also causes severe disabilities and distress to the person since it can interfere with their social, mental, emotional and occupational functioning.

History:

In 1908, Goldstein reported a case of patient with a stroke on right side of a brain and later claimed that her left leg felt weak. In 1944, Akelaitis reported cases of a patient with a sectioned corpus callosum after which his hand had involuntary movements. These doctors named the condition as Diagnostic Dyspraxia.

In 1972, Brion and Jedynak named the condition as Alien Hand Syndrome after analyzing the behavior of four patients with symptoms such as, problem in naming objects outside left hand field of vision, difficulty making movements with left hand, attention deficit and difficulty sending sensory information from one hand to another.

Causes:

It can be caused by several factors which could be:

• Stroke
• Trauma
• Tumor removal
• Cancer
• Brain Aneurysms (bulge or ballooning in the blood vessel in the brain)
• Neurodegenerative diseases ( the cells of the central nervous system stop working or die)
• Brain surgeries (incision along corpus callosum)
• Lesions in anterior cingulated cortex and supplementary motor cortex
• Damage in parietal cortex
• The condition often worsens in stressful situations

Symptoms:

The symptoms of Alien Hand Syndrome are:

• Inability to control hand
• Affected hand moves involuntarily
• Hand moves without cognitive control or awareness
• Hand may touch face, button a shirt, pick objects compulsively or repeatedly
• Hand may levitate on its own
• Hand is uncooperative
• Hands doesn’t follow command
• Hand feels foreign

Film Reference:

In 1964, Stanley Kubrick directed a film Dr Strangelove based on the novel Red Alert by Peter George. In this movie the character Strangelove experiences strange limb movements. His right hand seems to have a mind of its own and has involuntary and inappropriate movements where the doctor also tried to control these movements with his other hand. (Image 2)

Diagnosis:

Diagnosis may be a little difficult and complicated since it’s a neurological disorder which lacks psychiatric component. But the following are used for diagnosis:

• Observation
• Evaluation

Case studies:

1: In a report published in the Journal of Neurology, Neurosurgery and Psychiatry, Dr Ramón Leiguarda and his colleagues had a report of a 65 year old man who reported the following: “While I was travelling on a bus I noticed that a hand was approaching me on the right from behind, trying to catch me. After grasping my trouser leg, the hand did not release it. First, I thought somebody was assaulting me, but then realized that it was my own right hand, although I did not feel it belong to me. Thereafter, the fingers developed creeping movements and repetitive jerks involving the whole arm soon followed. I was unable to control my right hand and I had to grasp and hold it with my left hand. My right arm felt heavy and awkward. I was very anguished, anxious, frightened and had palpitations” (5)

2: A study conducted by Kikkert MA, Ribbers GM and Koudstaal PJ: A teacher in her 50s suffered from an acute ischemic stroke. Clinical examination revealed a left homonymous hemianopia, severe left spatial neglect, normal strength on right side and mild pareses of both her left arm and leg with hyperreflexia and a left extensor plantar response. Sensory functions were affected. CT scan of the brain was normal. She was shifted to rehabilitation after 2 weeks where the patient showed normal attention and memory functions. Speech was dysarthric and in normal range. Sensory functions were affected. Voluntary movement of left hand required visual control. Voluntary movements of right hand were accompanied by mirror movements of left hand. While the physical examination was done, the left land involuntarily grasped a pair of scissors. Patient reported loss of control of the left hand where it pulled her clothes and grabbed objects and persons. Left hand also interfered in her sleep as it would move under the blanket. While the patient walks, the left arm levitates causing imbalance. Both hands were made to perform activities of daily living (ADL), including mirror movements. Hand was constrained while walking by keeping it in pocket. Symptoms would worsen under mental and physical stress. At discharge, the patient could walk short distances and perform activities of daily living independently. (6)

3: A study conducted by Ihtehsham Aatif Qureshi, Daniel Korya and Mohammed Moussavi: An 84 years old woman complained of headaches and episodes of left arm moving to grab her own body. A CT scan demonstrated frontal and callosal lesions. There were no significant abnormalities in the insonated vessels. After being stabilized for the acute bleed, she was treated with Clonazepam 0.5 mgat night for the uncontrolled hand movements. Her movements resolved by the next months follow up. Diagnosis of AHS was based on her clinical presentation, characterization of the movement and localization correlating with findings in neuroimaging.  (7)

Treatment:

There is no known cure of Alien Hand Syndrome but scientists are working on treatments to reduce symptoms so that it doesn’t interfere with their mental, social and occupational functioning.

People who get Alien Hand Syndrome after brain illness or stroke may recover after a while but recovery is difficult for people with neurodegenerative diseases.

The various treatments that can be used to manage or treat the condition and its symptoms are:

• Muscle control therapies such as Botulinum toxin (Botox)
• Neuromuscular blocking agents
• Benzodiazepines (Benzo)
• Behavioral techniques
• Mirror box therapy
• Cognitive therapy techniques
• Learning task behavioral therapy
• Visuospatial coaching techniques
• Physical and occupational therapies
• Stress management
• Perception and control boost

Interesting facts:

• The first reported case of Alien Hand Syndrome was in 1908 reported by Dr Goldstein.
• Alien Hand Syndrome was officially recognized only in the year 1972.
• The hand can grab and tear owner’s clothes, attempt to strangle the sufferer, punch on the face, grab steering wheel and turn the vehicle around, unfasten owner’s trousers and gratify him regardless of the surroundings etc.
• In most of the cases, it impacts the left hand or non dominant hand.

Conclusion:

Alien Hand Syndrome is a rare condition but can be distressing to those few who get diagnosed with it. The ones suffering from Alien Hand Syndrome have said to be more triggered in conditions of fatigue, anxiety or stress. Rehabilitative treatments and therapies are undertaken to treat the symptoms and treatments to eradicate the root cause are under development. If science finds a treatment for the root cause of this syndrome then it could allow the improvement of the disabling impact it has on the daily life of the ones suffering.

My experience with the topic:

Honestly, I had no clue about the existence of alien hand syndrome. I never heard about it. Although I’m a big fan of Stanley Kubrick’s films, I might have failed to notice this particular condition. Nevertheless, we’re never too old to learn new things. It was a fun and informative topic. My research about this topic doesn’t end here, I will still make time to research and read more on this topic as well as educate those around me on the same. Awareness on such topics should be made to the general public in order to make people more empathetic towards others.

References:

• R. (2020, July 14). Alien Hand Syndrome. Exploring Your Mind.
• https://exploringyourmind.com/alien-hand-syndrome/
• Redd, W. (2019, January 4). Alien Hand Syndrome: What It Is And What Might Cause It. All That’s Interesting. https://allthatsinteresting.com/alien-hand-syndrome (Image 2)
• Panikkath, Panikkath, Mojumdar, & Nugent (2014, July 27). The Alien Hand Syndrome. Proceedings (Baylor University. Medical Centre). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059570/
• Cronkleton, E. (2018, September 18). What is Alien Hand Syndrome? Healthline. https://www.healthline.com/health/alien-hand-syndrome
• Alien Hand Syndrome. (2020, January 12). Damn Interesting. https://www.damninteresting.com/alien-hand-syndrome/
• Kikkert, M.A. (2006, May). Alien hand syndrome in stroke: a report of 2 cases and review of the literature. PubMed. https://pubmed.ncbi.nlm.nih.gov/16635638/
• Case Report: 84 year-old woman with alien hand syndrome. (2016). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155497/