異己手徵候群述評：現象學精神病理學與認知神經科學的雙視角

An Overview of Alien Hand Syndrome: A Dual Perspective from Phenomenological Psychopathology and Cognitive Neuroscience

異己手徵候群是神經精神病學領域內最引人注目的病理現象之一。按照現象學精神病理學的描述,患者的某只手似乎按照本身的意志呈現目的性的協調動作或姿勢,而另一隻手則試圖干擾和對抗這種正在進行的活動。這使得患者對自己的軀體感到陌生和疏遠,從而導致了自主感的喪失。當前的認知神經科學研究發現,大腦內外側系統的關係失調、內外部驅動系統的分離與功能紊亂以及神經-身體矩陣的扭曲可能是導致患者出現異己手症狀的神經病理學原因,而楔前葉與額下回是異己手運動的重要神經關聯物。行為康復訓練、藥物治療與物理治療被應用或設想用來治療該病症。未來的研究應注重建立異己手徵候群的標準症狀評估系統,實現第一人稱方法與第三人稱方法的交互約束,並通過實驗設計誘發正常受試的異己手體驗來深化對該病症發生機制的認識。

Alien hand syndrome (AHS) represents a remarkable neuropsychiatric disorder. According to phenomenological psychopathology, one of the patients hands displays purposeful, coordinated behavior or posture as if it has "a will of its own," with contrasting behavior that opposes or interferes with motor activities in the other hand. The patient therefore experiences "estranged body" feelings and loses their sense of bodily ownership. At present, it has been suggested that imbalance within the medial and lateral systems, the isolation and dysfunction of internal and external driving systems, and body-neuromatrix distortion could be among the leading causes of AHS. Both precuneus as well as the IFG may be regarded as neural correlates of alien hand movements. Additionally, effective therapeutic approaches including behavioral rehabilitation training, medical treatment, and physical therapy have been developed to counter AHS. The present paper summarizes recent advances in both basic knowledge and clinical interventions for AHS. In closing, we pro- pose that future studies should focus on the construction of a standard symptom assessment system, the achievement of the reciprocal constraints of the first person and third person methods, and the design of experiments that induce alien hand experiences in normal subjects that will help to further understand the mechanisms of AHS.