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• W2183611733 abstract "The phantom limb phenomenon constitutes a spectacular example of alteration in body scheme. It is common after amputation and commonly described following any interruption of the nervous tracks, such as the peripheral nerves, brachial plexus and spinal cord. Even if classical, phantom limbs are scarcely reported after central damage (supernumerary phantom limb). We studied a previously unreported form of supernumerary limb, which specifically developed with motor intent in a patient with severe sensorimotor hemiparesis following anterior choroidal artery territory infarction. A cognitive model of motor control was used to interpret this persisting kinaesthesicproprioceptive phantom illusion of a third arm. According to this model, action initiation awareness depends upon a representation of the predicted consequences of action execution rather than on its actual consequences (because sensory feedback from the moving limb itself is delayed relative to the actual movement). This 'premovement brain signal of action', called 'efference copy', relies on the integrity of controllers which provide the motor commands necessary to achieve a desired movement and the predictors which estimate the sensory consequences of the ensuing action. As a consequence, a patient with a paralysed limb may feel that his limb is moving, provided that the motor output system is functional together with a failure to register the discrepancy between predicted and actual limb states. We suggest that in our patient, motor commands could still be issued leading to prediction of movement. Because of the absence of contradictory sensory feedback, the concordance between intended and predicted movement could lead to the illusion of movement and supernumerary limb. Finally, the interruption of thalamic afferences probably prevented any insight into the mismatch between expected and effective movement, allowing the persistence and stability of the kinaesthetic illusion. In a second step, haemodynamic correlates of supernumerary phantom limb were studied with an fMRI motor paradigm showing an increased activity in the basal ganglia-thalamus-cortex pathway during virtual movement of the supernumerary hand. We suggest that this fMRI activation reflected an abnormal closed-loop functioning of the thalamocortical system due to interruption of sensory inputs, while integrity of predictors allowed the generation of the internal phantom representation of limb position. Our findings demonstrate that supernumerary phantom limb may develop and persist after a deep brain lesion sparing cortex and provide new contributions to the critical role of the motor system in the genesis of body scheme distortions. Our study indeed shows how a preserved sense of agency provided by intact pre-motor processes translating intention into action can lead to the feeling of a non-executed movement in a paralysed limb." @default.
• W2183611733 created "2016-06-24" @default.
• W2183611733 date "2005-05-04" @default.
• W2183611733 modified "2023-10-02" @default.
• W2183611733 title "Identité et appartenance corporelle: fantômes et membres surnuméraires" @default.
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• W2183611733 doi "https://doi.org/10.4414/sanp.2005.01603" @default.
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