POST-CALLOSOTOMY ALIEN HAND SYNDROME
A Cukiert, JA Burattini, PP Mariani, CM Cukiert, C Baise-Zung, M Argentoni-Baldochi, CR Forster, VA Mello.
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo SP, Brazil
Alien hand syndrome had been reported in patients with heterogeneous brain lesions. Although it has also been reported after callosal section, its occurrence is extremely rare after this procedure. We describe a patient who had a transient alien hand syndrome after maximized (90%) callosal section.
This 43 year-old man presented with refractory simple absence and tonic-clonic seizures since the age of 7 years. His MRI was normal and his mean IQ=85. Interictal and ictal EEG showed diffuse bilateral and synchronous spike and wave discharges, prevailing over the frontal regions. He underwent an uneventful 90% callosal section. The extent of section was documented by post-operative MRI and his post-operative EEG showed complete disruption of the secondary bilateral synchronous and asynchronous spike and wave discharges. One month after surgery, the general IQ remained stable. There was a 90% improvement in seizure frequency and marked improvement in attention. Immediately after surgery, he was unable to perform any bimanual task. Actually, the left hand would always interrupt or disturb the movement intention of the right hand. He remained highly incapacitated due to this condition for one week, after which the symptoms started to vanished. The symptoms disappeared forty-five days postoperatively.
Although rare, this transient condition could be highly disruptive of the normal daily activities. It is rarely seen postoperatively in callosotomy patients. This was the first time we documented this syndrome in our 133 callosotomy patients series. It might represent a very severe transient intermanual conflict deficit.