Continuous dopaminergic stimulation: Is it the answer to the motor complications of levodopa?

✍ Scribed by Mario Zappia; Aldo Quattrone

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 42 KB
• Volume: 23
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.21819

✦ Synopsis

cited cases also exhibited sensory loss and neglect. However, their postulated explanation might be plausible only for nondominant hemispheric involvement. In cases like ours, where the lesion involves the dominant hemisphere with no neglect or significant sensory loss, a posterior parietal lesion might not be enough. The appearance of alien hand might then require the constellation of a posterior parietal lesion and interhemispheric disconnection as in our patient. A review of the literature concerning patients with dominant posterior alien hand (Table 1) revealed only two detailed cases. One patient had significant sensory loss, no callosal involvement, 5 while the other patient had no sensory loss but demonstrated other disconnection syndromes suggesting the involvement of the corpus callosum 6 as in our patient. The generation of alien hand might require the incongruity between the visual input, body scheme and motor intention. Since the representation of body scheme is probably prominent in the nondominant posterior parietal lobe, deficient flow of information from this area due to a posterior callosal lesion may contribute to a dominant alien hand phenomenon.

We suggest that the mechanisms underlying some dominant hemispheric alien hands might differ from those of nondominant posterior alien hand with accompanying neglect and sensory loss. In such cases, the possible prerequisite of co-occurrence of a posterior parietal and corpus callosum lesion might explain their scarcity and reported paucity.