Conflict of intentions due to callosal disconnection

Abstract

Objectives-Three patients with callosal syndrome manifested a peculiar symptom in that they were unable to perform intended whole body actions because another intention emerged in competition with the original one. Attempts were made to clarify the symptomatology of this manifestation and its possible mechanism is discussed. Methods-The three patients are described and previous reports on patients with callosal damage were reviewed. Four additional patients with similar symptoms were found and the clinical features common to all seven patients were examined. Results-This symptom could not be attributed to unilateral movement disorders such as unilateral apraxia, intermanual conflict, or compulsive manipulation of tools. The manifestations included marked hesitation in initiating actions, interruption of actions, repetitive actions, and performance of unintended actions with diYculty in correcting them. All patients, except one, had a lesion in the posterior half of the body of the corpus callosum, and there was no significant involvement of the cerebral cortex. The symptom became manifest later than 4 weeks after callosal damage. It occurred during spontaneous actions, but not during well automated actions nor when following instructions. Conclusion-This symptom, tentatively named "conflict of intentions", can be regarded as a fragment of diagonistic dyspraxia originally described by Akelaitis, although it can occur independently of intermanual conflict. Normally, the right and left cerebral hemispheres may be complementarily modifying automated whole body actions in order to adapt behaviour to changes of the environment as well as to the intention. Partial callosal disconnection without significant cortical involvement would exaggerate the disparity between the role of each hemisphere through the reorganisation of neural systems after callosal damage. Such double, often contrary, behavioural tendencies may sometimes simultaneously enter the patient's awareness. (J Neurol Neurosurg Psychiatry 2001;71:462-471)

The mirror world of motor inhibition: the alien hand syndrome in chronic stroke

“…Nishikawa et al 24 report three patients with conflicting wills that result in “freezing” and despair. We have also seen “conflict of intentions” in our patients outside the testing or therapeutic settings—for example, when patient No.…”

Clinical callosum syndrome in a case of multiple sclerosis

“…Despite the fact that her behaviors do not fulfill all criteria defined by Nishikawa et al. (2001) to reflect a conflict of intentions, DA's behaviors could not be considered as a diagonistic dyspraxia nor as an alien hand.…”

“…More recently, Nishikawa et al (2001) have described a new strange manual behavior associated with callosal disconnection and named Ôconflict of inten-tionsÕ. This behavior is not confined to one side of the body.…”

The alien hand syndrome: What makes the alien hand alien?

“…Patients with AHS have even woken up to find their alien limbs choking them (Banks et al, 1989). Perhaps the most peculiar abnormal movement in the AHS is diagonistic apraxia (Akelaitis, 1944(Akelaitis, -1945McNabb, Carroll, & Mastaglia, 1988;Nishikawa et al, 2001;Tanaka, Iwasa, & Yoshida, 1990;Tanaka, Yoshida, Kawahata, Hashimoto, & Obayashi, 1996), in which one hand acts in opposition to the other. For example, a patient reported by Bogen (1993) found his alien hand undoing the buttons of his shirt even as his "healthy" limb tried to button the shirt.…”

“…A variant of the syndrome can be seen with thalamic or parietal damage (Bundick & Spinella, 2000;Levine & Rinn, 1986;Marey-Lopez, Rubio-Nazabal, Alonso-Magdalena, & Lopez-Facal, 2002;Nishikawa et al, 2001;Ventura, Goldman, & Hildebrand, 1995) and with cortico-basal degeneration (Kompoliti et al, 1998).…”