Pacella Valentina, Bertagnoli Sara, Danese Riccardo, Bulgarelli Cristina, Gobbetto Valeria, Ricciardi Giuseppe Kenneth, Moro Valentina
Scuola Universitaria Superiore IUSS, Pavia, Italy; Brain Connectivity and Behaviour Laboratory Sorbonne Universities Paris, France.
Social and Cognitive Neuroscience Laboratory, Department of Psychology, University La Sapienza, Roma, Italy.
Cortex. 2025 Jan;182:181-194. doi: 10.1016/j.cortex.2024.10.017. Epub 2024 Nov 19.
An individual's inability to control the movements of their own hand is known as the Anarchic Hand Syndrome. The hand may perform apparently purposeful actions but acts as if it has a will of its own. Although the syndrome was first described over a century ago, the nature of the condition remains, for the most part, obscure, in particular in terms of the definition of the main symptoms and the underlying neural networks. The present study compares the results from in-depth assessments, made at repeated intervals (2, 4 and 7 months from the lesion onset) of the anarchic hand symptoms in three patients suffering from various different forms of brain damage. An investigation of direct grey matter damage and structural connectivity allowed us to compare the grey matter lesions and white matter disconnections in the three patients. A "core" characteristic relating to anarchic hand symptoms was identified, involving, in particular, both apparently purposeful movements (i.e., magnetic apraxia, grasping, bimanual incoordination, disorders in manual dexterity and action sequencing) and non-purposeful movements (i.e., levitation, synkinesis and mirror movements). Furthermore, ideomotor apraxia may also be associated with this syndrome. No overlapping areas of grey matter lesions were found in the three patients. In contrast, a pattern of common white matter disconnections was found, which involves inter-hemispheric disconnections (via corpus callosum), the long intra-hemispheric tracts (via SLF, IFOF and Arcuate) and the descendent tracts (corticospinal tract). These results are discussed in terms of awareness of motor intention.
个体无法控制自己手部的运动被称为异己手综合征。手部可能会做出明显有目的的动作，但却像是有自己的意志一样自行其是。尽管该综合征在一个多世纪前就首次被描述，但这种病症的本质在很大程度上仍然模糊不清，尤其是在主要症状的定义和潜在神经网络方面。本研究比较了对三名患有不同形式脑损伤的患者在不同时间间隔（从损伤发作起2个月、4个月和7个月）对异己手症状进行深入评估的结果。对直接灰质损伤和结构连接性的调查使我们能够比较这三名患者的灰质病变和白质连接中断情况。确定了一个与异己手症状相关的“核心”特征，尤其涉及明显有目的的动作（即磁性失用症、抓握、双手不协调、手部灵活性和动作序列障碍）和无目的的动作（即肢体悬浮、联带运动和镜像运动）。此外，观念运动性失用症也可能与该综合征有关。在这三名患者中未发现灰质病变的重叠区域。相反，发现了一种常见的白质连接中断模式，其中包括半球间连接中断（通过胼胝体）、长的半球内束（通过上纵束、下额枕束和弓状束）以及下行束（皮质脊髓束）。从运动意图的意识方面对这些结果进行了讨论。
