Alien Hand Syndrome

By: Bhavya Malhotra 

1. Introduction to the Alien Hand Syndrome 

Alien hand syndrome, or Dr. Strangelove syndrome, is an interesting situation in which a person loses control of his or her hand, and starts to act independently. It describes the involuntary complex goal-directed activity of one limb. Recent usage of the term “alien hand” is more liberal and requires having observable involuntary motor activity along with the feeling that the limb is foreign or that it has a will of its own (2). The syndrome has been reported after surgery on the corpus callosum and with brain tumors, aneurysms, degenerative diseases of the brain, and uncommonly stroke. Alien hand as a manifestation of cardioembolic stroke is extremely rare, with only a few cases reported in the literature. 

Alien hand syndrome has been reported to be associated with several abnormal involuntary movements when different regions of the brain, like the corpus callosum, parietal region, or frontal region, are involved. It can be classified into at least four categories: 

1) Diagnostic dyspraxia/intermanual conflict (when one hand performs actions contrary to the other hand). 

2) Alien hand sign (a subjective feeling that the hand is not one's own). 

3) Syndrome of anarchic hand (when the affected hand performs goal-directed activity not under the will of the person). 

4) Supernumerary hand (a feeling of having an extra limb). Another type of alien hand is the levitating hand, where the affected limb tends to levitate without volitional action. (R Panikkath 2014, NIH) 

2. Symptoms of Alien hand syndrome :

People with AHS may experience a variety of involuntary movements from the affected limb, such as: 

● Self-groping (e.g. touching the face) 

● Goal-directed tasks (e.g. buttoning up a shirt) 

● Grasping objects 

● Refusal to release held objects 

● Levitating (rising into the air) 

● Oppositional actions (e.g. closing a drawer that the unaffected hand has just opened) 

● Self-suffocation 

● Less purposeful movements like waving around. 

The patient might display auto criticism in response to these involuntary movements, for example, slapping the ‘alien’ hand with their unaffected hand (Panikkath et al. 2014). 

AHS seems to present differently depending on the area of the brain that has been injured. For example, damage to one side of the frontal lobe often causes the hand on the opposite side of the body to perform purposeful movements such as reaching and grasping, and the person might have difficulty releasing an object being held. Posterior injury seems to cause the affected limb to withdraw rather than reach, and it may ‘levitate’ upward and away from surfaces. Corpus callosum injury appears to affect the person’s non-dominant hand and causes intermanual conflict (where the hands perform opposing actions) (Bionity nod). (Amused nod). 

3. Causes of the syndrome : 

There isn’t one universal cause for alien hand syndrome. But it’s always caused by some kind of damage to your brain in a way that disrupts your movement and control. 

Usually, when someone chooses to start moving their arm, they activate multiple extensive neural networks within their brain. In people with AHS, the areas of activation are more isolated.

On a broader level, causes of brain damage that can lead to AHS include: 

● Strokes 

● Aneurysms 

● Brain damage from an injury 

● As a side effect of brain surgery 

● Parry–Romberg Syndrome 

It’s highly unlikely that you’ll develop AHS if you have a stroke, but for some specific conditions, the rate can be surprisingly high. Data indicates that it appears in 30% of people with the Parkinson’s variant — corticobasal syndrome. It also occurs in 4% of people with Creutzfeldt–Jakob disease. In some cases, the condition is idiopathic — meaning that the exact cause remains unknown. (VW Mark 13 February, 2024) 

4. How Is Alien Hand Syndrome Diagnosed? 

Because of its rarity, there are only a few handfuls of reported cases in the scientific literature some doctors may not be familiar with this condition. 

When you see a doctor, try to remember the exact actions that your hand has been doing and how it’s made you feel. These details will help rule out motor-based dysfunction. Your doctor will also need to know your full health history, including all of your medications and the doses you’ve taken lately. 

The next step is to look at your brain to try to figure out the underlying cause. Your doctor may order any combination of the following imaging procedures: 

● Magnetic resonance imaging (MRI) 

● A computed tomography (CT) scan 

5. Alien Hand Syndrome Treatment 

There is no treatment for alien hand syndrome. All techniques to manage it are mostly anecdotal. The techniques that people have tried have attempted to

address both the physical and psychological complications caused by AHS. These include: 

● Cognitive behavioral therapy: This can help people come to terms with the emotional realities of their condition. It helps them to think about their alien hand in new ways. 

● Distracting the hand: Some people have found it helpful to occupy the alien hand with simple and non-embarrassing tasks to keep it distracted. This can be as easy as having your out-of-control hand hold a magazine as you go about your day. 

● Visuospatial coaching techniques: This strategy attempts to help with your perception of the alien limb about the rest of your body — hopefully well enough for you to regain some control. 

● Clonazepam. There’s one reported case where a 13-year-old girl, whose right arm was affected by AHS, took clonazepam in an attempt to treat her symptoms. It led to a 70% reduction in her symptoms after 2 days. Unfortunately, the drug did not agree with her, so they had to try another technique. 

● Botulinum toxin injections: The same 13-year-old girl was injected with botulinum toxin in a few areas up and down her affected arm. This showed an 80% reduction in her symptoms. ( WebMD, 5 Jun 2024 ) 

6. Case studies : 

● An 84-year-old woman presented to the emergency department complaining of headaches and several episodes of her left arm moving as if it was groping around trying to grab at her own body. A computed tomography scan of the head demonstrated an acute left superior frontal hemorrhage with compression of the corpus callosum. Transcranial Doppler report showed no significant abnormality in the insonated vessels. After being stabilized for the acute bleed, she was treated with clonazepam 0.5 mgat night for uncontrolled hand movements. Her movements were resolved by her next month's follow-up. The diagnosis of AHS was made based on her clinical presentation, characterization of the movement,

and localization correlating with findings in neuroimaging. (IA Qureshi 2016 ) 

7. References : 

● Ragesh Panikkath, 2014 MD, Texas Tech University Health Sciences Center School of Medicine The alien hand syndrome 

https://pmc.ncbi.nlm.nih.gov/articles/PMC4059570/ 

● IA Qureshi 2016, Case Report: 84-year-old woman with alien hand syndrome https://pmc.ncbi.nlm.nih.gov/articles/PMC5155497/ 

● Alyssa Anderson June 05, 2024, What Is Alien Hand Syndrome? https://www.webmd.com/brain/what-is-alien-hand-syndrome 

● Victor W Mark MD February 13 , 2024 , Alien hand syndrome , https://www.medlink.com/articles/alien-hand-syndrome