Clonazepam and botulinum toxin for the treatment of alien limb phenomenon.

We discuss a patient who developed an "alien limb" on her right side after brain herniation. She reported feeling as though her arm movements were controlled by a stranger and displayed limb levitation and groping behaviors. She received 0.5 mg clonazepam b.i.d. This was followed by a limb levitation frequency reduction of 73%. Discontinuation and retrial of clonazepam verified this response. She suffered a psychotic episode that she attributed to clonazepam. Clonazepam was discontinued. She received botulinum toxin injections to her arm that reduced her limb levitation by 84%. This is the first report of response to medication in alien limb syndrome.

[1]  M. Colombi,et al.  ISCHEMIC STROKE IN AN ADOLESCENT WITH ARTERIAL TORTUOSITY SYNDROME , 2006, Neurology.

[2]  S. Cruz-Flores,et al.  Position‐dependent levitation of the dominant arm after left parietal stroke: An unreported feature of posterior alien limb syndrome? , 2005, Movement disorders : official journal of the Movement Disorder Society.

[3]  M. Okun,et al.  Alien limb syndrome and moya–moya disease , 2004, Movement disorders : official journal of the Movement Disorder Society.

[4]  F. Patti,et al.  Posterior Alien Hand Syndrome: Case Report and Rehabilitative Treatment , 2004, Neurorehabilitation and neural repair.

[5]  J. Schmahmann.  Vascular syndromes of the thalamus. , 2003, Stroke.

[6]  M. Hamann,et al.  Effects of striatal injections of GABA(A) receptor agonists and antagonists in a genetic animal model of paroxysmal dystonia. , 2002, European journal of pharmacology.

[7]  P. Diamond,et al.  Posterior-variant alien hand syndrome: clinical features and response to rehabilitation , 2002, Disability and rehabilitation.

[8]  C. Buchpiguel,et al.  Involuntary hand levitation associated with parietal damage: another alien hand syndrome. , 2001, Arquivos de neuro-psiquiatria.

[9]  D. Gunal,et al.  A case of spontaneous arm levitation in progressive supranuclear palsy , 2000, Neurological Sciences.

[10]  C. Kevorkian,et al.  Ego-syntonic alien hand syndrome after right posterior cerebral artery stroke. , 1999, Archives of physical medicine and rehabilitation.

[11]  M. Hallett.  Is dystonia a sensory disorder? , 1995, Annals of neurology.

[12]  G. Goldberg,et al.  The Alien Hand Sign: Localization, Lateralization and Recovery , 1990 .

[13]  F. Mastaglia,et al.  "Alien hand" and loss of bimanual coordination after dominant anterior cerebral artery territory infarction. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[14]  C. Jedynak,et al.  [Disorders of interhemispheric transfer (callosal disonnection). 3 cases of tumor of the corpus callosum. The strange hand sign]. , 1972, Revue neurologique.

[15]  P. Gorelick,et al.  "Naturalization" of the alien hand: case report. , 1998, Archives of physical medicine and rehabilitation.

[16]  F. Lisovoski,et al.  Left tuberothalamic artery territory infarction: neuropsychological and MRI features. , 1993, European neurology.