Blanke Olaf, Morgenthaler Florence D, Brugger Peter, Overney Leila S
Laboratory of Cognitive Neuroscience, Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Department of Neurology, University Hospital, Zürich, Switzerland.
J Neuropsychol. 2009 Sep;3(Pt 2):181-200. doi: 10.1348/174866408X318653. Epub 2008 Aug 20.
Reports of able-bodied participants with the persisting desire for limb amputation raise legal and ethical questions that are partly due to insufficient empirical knowledge about the condition. Here, we searched for potential neurological mechanisms in participants with desire for limb amputation in order to help develop adequate nosological classifications, diagnosis, and treatment.
Semi-structured interviews were carried out with 20 participants who self-identified themselves as able-bodied individuals desiring amputation of a limb.
The results suggest that amputation desire is not unspecific, but in most cases specific for a circumscribed part of the body. Most frequently affected was the leg, mostly on the left, non-dominant side. Left-sidedness and limb specificity was associated with elementary and complex somatosensory disturbances of the affected limb akin to those reported by neurological patients. The most frequent neurological co-morbidity was migraine headache.
These results document the existence of an unusual condition in able-bodied participants characterized by a person's desire for the amputation of one or more particular limbs. Left-sidedness, limb specificity and somatosensory disturbances of the affected limb are suggestive of abnormal brain mechanisms in right fronto-parietal cortex. Based on this association we suggest that desire for limb amputation may be conceptualized as asomatognosia due to disturbed integration of multi-sensory information of the affected body parts into a coherent cerebral representation of the own body. This suggestion has to be regarded with caution as we did not perform any neurological examination.
关于身体健全的参与者持续渴望截肢的报道引发了法律和伦理问题，部分原因是对这种情况的实证知识不足。在此，我们探寻渴望截肢的参与者潜在的神经机制，以帮助制定适当的疾病分类、诊断和治疗方法。
对20名自我认定为渴望截肢的身体健全个体进行了半结构化访谈。
结果表明，截肢渴望并非不具特异性，而是在大多数情况下特定于身体的某一限定部位。最常受影响的是腿部，大多为左侧、非优势侧。左侧性和肢体特异性与受影响肢体的基本和复杂躯体感觉障碍相关，类似于神经科患者所报告的情况。最常见的神经合并症是偏头痛。
这些结果证明了身体健全的参与者中存在一种不寻常的情况，其特征是个体渴望截肢一个或多个特定肢体。左侧性、肢体特异性和受影响肢体的躯体感觉障碍提示右额顶叶皮质存在异常脑机制。基于这种关联，我们建议将截肢渴望概念化为一种自体认识不能，这是由于受影响身体部位的多感官信息整合紊乱，无法形成连贯的自身身体大脑表征所致。由于我们未进行任何神经学检查，此建议应谨慎看待。
