Département de Médecine

ObjectiveSupernumerary phantom limb (SPL) is a rare neurological manifestation where patients with a severe stroke-induced sensorimotor deficit experience the illusory presence of an extra limb that duplicates a real one. The illusion is most often experienced as a somesthetic phantom, but rarer SPLs may be intentionally triggered or seen. Here, we report the case of a left visual, tactile, and intentional SPL caused by right subcortical damage in a nondeluded woman.Supernumerary phantom limb (SPL) is a rare neurological manifestation where patients with a severe stroke-induced sensorimotor deficit experience the illusory presence of an extra limb that duplicates a real one. The illusion is most often experienced as a somesthetic phantom, but rarer SPLs may be intentionally triggered or seen. Here, we report the case of a left visual, tactile, and intentional SPL caused by right subcortical damage in a nondeluded woman.MethodsUsing functional magnetic resonance imaging, we investigated the multimodal nature of this phantom, which the patient claimed to be able see, use, and move intentionally. The patient participated in a series of sensorimotor and motor imagery tasks involving the right, the left plegic, and the SPL's hand.Using functional magnetic resonance imaging, we investigated the multimodal nature of this phantom, which the patient claimed to be able see, use, and move intentionally. The patient participated in a series of sensorimotor and motor imagery tasks involving the right, the left plegic, and the SPL's hand.ResultsRight premotor and motor regions were engaged when she imagined that she was scratching her left cheek with her left plegic hand, whereas when she performed the same task with the SPL, additional left middle occipital areas were recruited. Moreover, comparison of responses induced by left cheek (subjectively feasible) versus right cheek scratching (reportedly unfeasible movement) with the SPL demonstrated significant activation in right somesthetic areas.Right premotor and motor regions were engaged when she imagined that she was scratching her left cheek with her left plegic hand, whereas when she performed the same task with the SPL, additional left middle occipital areas were recruited. Moreover, comparison of responses induced by left cheek (subjectively feasible) versus right cheek scratching (reportedly unfeasible movement) with the SPL demonstrated significant activation in right somesthetic areas.InterpretationThese findings demonstrate that intentional movements of a seen and felt SPL activate premotor and motor areas together with visual and sensory cortex, confirming its multimodal dimension and the reliability of the patient's verbal reports. This observation, interpreted for cortical deafferentation/disconnection caused by subcortical brain damage, constitutes a new but theoretically predictable entity among disorders of bodily awareness. Ann Neurol 2009;65:698–705These findings demonstrate that intentional movements of a seen and felt SPL activate premotor and motor areas together with visual and sensory cortex, confirming its multimodal dimension and the reliability of the patient's verbal reports. This observation, interpreted for cortical deafferentation/disconnection caused by subcortical brain damage, constitutes a new but theoretically predictable entity among disorders of bodily awareness. Ann Neurol 2009;65:698–705

Honoré de Balzac (1799–1850) is well known for his penetrating observations and descriptions of the burgeoning social life and emerging modernity of 19th century France. This chapter focuses on the novel Louis Lambert, first published in 1832. It is argued that its main character provides the first complete and convincing description of schizophrenia – 69 years before Kraepelin fully developed the concept of dementia praecox and 76 years before Bleuler coined the word ‘schizophrenia’. We consider the history of the concept of schizophrenia and the intriguing possibility that it is a recent disease. Indeed, if schizophrenia had always existed, it would seem odd that Balzac’s novel should be the very first convincing and complete literary account of the disease. This claim is examined by a thorough description of Louis Lambert’s symptoms as they appear in the text, and compared to other claims of priority (namely, Shakespeare’s King Lear and Gogol’s Diary of a Madman). The chapter also provides some background on Balzac’s relationship with mysticism, mental illness, and the world of psychiatry. We conclude with remarks regarding influences of Louis Lambert, the case for the priority of the novel as the princeps case of schizophrenia, and its relevance to the recency hypothesis of schizophrenia.