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From the Neurobehavior and Alzheimer's Disease Center, Beth Israel Medical Center, and the Departments of Neuroiogy (Drs. Feinberg, Schindler, and Haber) and Psychiatry (Dr. Feinberg aid N.G. Flanagan), Mount Sinai School of Medicine and Beth Israel Medical Center, New York, NY.
Review of the clinical characteristics and neuroanatomy of 20 reported cases of alien hand syndrome (AHS) and a patient of our own confirm that AHS is actually two distinct syndromes. Frontal AHS occurs in the dominant hand; is associated with reflexive grasping, groping, and compulsive manipulation of tools; and results from damage to the supplementary motor area, anterior cingulate gyrus, and medial prefrontal cortex of the dominant hemisphere and anterior corpus callosum. Callosal AHS is characterized primarily by intermanual conflict and requires only an anterior callosal lesion. The occurrence of frontal AHS in the dominant limb can be explained by an increased tendency for dominant limb exploratory reflexes coupled with release from an asymmetrically distributed, predominant nondominant-hemisphere inhibition. Callosal AHS is best explained by hemispheric disconnection manifested during behaviors requiring dominant-hemisphere control.
Address correspondence and reprint requests to Dr. Todd E. Feinberg, Neurobehavior Center, Beth Israel Medical Center, 317 East 17th Street, New York, NY 10003.
Presented in part at the 43rd annual meeting of the American Academy of Neurology, Boston, MA, April 1991.
Received May 8, 1991. Accepted for publication in final form July 3, 1991.
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