Anarchy in the brain: Behavioural and neuroanatomical core of the anarchic hand syndrome

An individual's inability to control the movements of their own hand is known as the Anarchic Hand Syndrome. The hand may perform apparently purposeful actions but acts as if it has a will of its own. Although the syndrome was first described over a century ago, the nature of the condition remains, for the most part, obscure, in particular in terms of the definition of the main symptoms and the underlying neural networks. The present study compares the results from in-depth assessments, made at repeated intervals (2, 4 and 7 months from the lesion onset) of the anarchic hand symptoms in three patients suffering from various different forms of brain damage. An investigation of direct grey matter damage and structural connectivity allowed us to compare the grey matter lesions and white matter disconnections in the three patients. A "core" characteristic relating to anarchic hand symptoms was identified, involving, in particular, both apparently purposeful movements (i.e., magnetic apraxia, grasping, bimanual incoordination, disorders in manual dexterity and action sequencing) and non-purposeful movements (i.e., levitation, synkinesis and mirror movements). Furthermore, ideomotor apraxia may also be associated with this syndrome. No overlapping areas of grey matter lesions were found in the three patients. In contrast, a pattern of common white matter disconnections was found, which involves inter-hemispheric disconnections (via corpus callosum), the long intra-hemispheric tracts (via SLF, IFOF and Arcuate) and the descendent tracts (corticospinal tract). These results are discussed in terms of awareness of motor intention.