Source of text below: http://en.wikipedia.

org/wiki/Hemispherectomy

Hemispherectomy is a surgical procedure where one cerebral hemisphere

(half of the brain) is removed or disabled. This procedure is used to treat a
variety of seizure disorders where the source of the epilepsy is localized to a
broad area of a single hemisphere of the brain. It is solely reserved for extreme
cases in which the seizures have not responded to medications and other less
invasive surgeries.

History and changes

Hemispherectomy was first tried on a dog in 1888 by Friedrich Goltz. The first
such operation on humans was done by Walter Dandy in 1923 for glioblastoma
multiforme. In the 1960s and early 1970s, hemispherectomy involved removing
half of the brain, but this resulted in unacceptable complications and side effects
in many cases, predominantly filling of excessive body fluids in the skull with
subsequent pressure to the remaining brain (known as hydrocephalus). The
procedure was revitalized in children in the 1980s by Dr. Ben Carson at The
Johns Hopkins Hospital. In many centers, the functional hemispherectomy
has largely replaced this procedure, in which the temporal lobe is removed; a
procedure known as corpus callosotomy is performed; and the frontal and
occipital lobes are disconnected from the rest of the brain; however the traditional
"anatomic" hemispherectomy has remained a viable procedure, due to its
superiority in preventing future seizures compared with functional
hemispherectomy.

Results

All hemispherectomy patients suffer at least partial hemiplegia on the side of the
body opposite the removed or disabled portion, and may suffer problems with
their vision as well.

This procedure is almost exclusively performed in children because their brains

generally display more neuroplasticity, allowing neurons from the remaining
hemisphere to take over the tasks from the lost hemisphere. This likely occurs by
strengthening neural connections which already exist on the unaffected side but
which would have otherwise remained small in a normally functioning, uninjured
brain.[1] One case, demonstrated by Smith & Sugar, 1975; A. Smith 1987,
demonstrated that one patient with this procedure had completed college,
attended graduate school and scored above average on intelligence tests.
Studies have found no significant long-term effects on memory, personality, or
humor after the procedure[2], and minimal changes in cognitive function overall.
[3] Generally, the greater the intellectual capacity of the patient prior to surgery,
the greater the decline in function. Most patients end up with mild to severe
mental retardation, which is usually already present before surgery. When
resectioning the left hemisphere, evidence indicates that some advanced
language functions (i.e., higher order grammar) cannot be entirely assumed by
the right side. The extent of advanced language loss is often dependent on the
patient's age at the time of surgery.[4]

Although initially thought to be limited solely to children, a recent study in 2007 by

Dr. Shearwood McClelland III and Dr. Robert E. Maxwell indicated the long-term
efficacy of anatomic hemispherectomy in carefully selected adults, with seizure
control sustainable over multiple decades.[5]
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Source of text below: http://en.wikipedia.org/wiki/Alien_hand_syndrome

Alien hand syndrome (also known as anarchic hand or Dr.

Strangelove syndrome[1]) is an unusual neurological disorder in which one
of the sufferer's hands seem to take on a mind of its own. AHS is best
documented in cases where a person has had the two hemispheres of their brain
surgically separated, a procedure sometimes used to relieve the symptoms of
extreme cases of epilepsy. It also occurs in some cases after other brain surgery,
strokes, or infections.

Symptoms

An alien hand sufferer can feel normal sensation in the hand and leg, but
believes that the hand, while still being a part of their body, behaves in a manner
that is totally distinct from the sufferer's normal behavior. They lose the 'sense of
agency' associated with the purposeful movement of the limb while retaining a
sense of 'ownership' of the limb. They feel that they have no control over the
movements of the 'alien' hand, but that, instead, the hand has the capability of
acting autonomously — i.e., independent of their voluntary control. The hand
effectively has 'a will of its own.' Alien hands can perform complex acts such as
undoing buttons, removing clothing, and manipulating tools. Alien behavior can
be distinguished from reflexive behavior in that the former is flexibly purposive
while the latter is obligatory. Sometimes the sufferer will not be aware of what the
alien hand is doing until it is brought to his or her attention, or until the hand does
something that draws their attention to its behavior.

A related syndrome described by the French neurologist François Lhermitte

involves the release through disinhibition of a tendency to compulsively utilize
objects that present themselves in the surrounding environment around the
patient (Lhermitte 1983; Lhermitte et al. 1986). The behavior of the patient is, in a
sense, obligatorily linked to the "affordances" (using terminology introduced by
the American ecological psychologist, James J. Gibson) presented by objects
that are located within the immediate peri-personal environment. This condition,
termed "utilization behavior", is most often associated with extensive bilateral
frontal lobe damage and might actually be thought of as "bilateral" alien hand
syndrome in which the patient is compulsively directed by external environmental
contingencies (e.g., the presence of a hairbrush on the table in front of them
elicits the act of brushing the hair) and has no capacity to "hold back" and inhibit
pre-potent motor programs that are obligatorily linked to the presence of specific
external objects in the peri-personal space of the patient. When the frontal lobe
damage is bilateral and generally more extensive, the patient completely loses
the ability to act in a self-directed manner and becomes totally dependent upon
the surrounding environmental indicators to guide his behavior in a general social
context, a condition also identified by Lhermitte (1986), and referred to as
"Environmental Dependency Syndrome".

Sufferers of alien hand will often personify the rogue limb, for example believing it
to be "possessed" by some intelligent or alien spirit or an entity that they may
name or identify. There is a clear distinction between the behaviors of the two
hands in which the affected hand is viewed as "wayward" and sometimes
"disobedient" and generally out of the realm of their own voluntary control, while
the unaffected hand is under normal volitional control. At times, particularly in
patients who have sustained damage to the corpus callosum that connects the
two cerebral hemispheres (see also split-brain), the hands appear to be acting in
opposition to each other. For example, one patient was observed putting a
cigarette into her mouth with her intact, 'controlled' hand (her right, dominant
hand), following which her alien, non-dominant, left hand came up to grasp the
cigarette, pull the cigarette out of her mouth, and toss it away before it could be lit
by the controlled, dominant, right hand. The patient then surmised that "I guess
'he' doesn't want me to smoke that cigarette." This type of problem has been
termed "intermanual conflict" or "diagonistic Ideomotor apraxia."

This condition has been thought to provide a fascinating window into the nature
of human consciousness as it relates to voluntary action, processes underlying
decision making and conscious volition, as well as the general nature of human
agency and intentionality. It provides insight into the neural mechanisms involved
in the emergence of a sense of agency association with bodily action. Besides its
relevancy to the understanding of the neurobiologic basis of human action and
volition/intentionality, these observations would appear to have significant
relevance for the general philosophy of action. In that the recognition and study
of this condition depends upon linking an observation of a particular behavior—
the appearance of a purposeful limb action—to either a direct report or inference
regarding the subjective experience of the actor associated with producing the
movement, and then correlating this transformed relation with brain
pathophysiology, alien hand syndrome and its study may be viewed as within the
purview of neurophenomenology. Furthermore, the dissociation of the sense of
agency from the sense of ownership that is observed in alien hand syndrome can
also be seen in other neuropsychiatric conditions, such as schizophrenia, and
may serve to help provide insight into the neural mechanisms underlying these
conditions.

Subtypes

There are several distinct subtypes of alien hand syndrome that appear to be
associated with specific distributions of associated brain injury. Damage to the
corpus callosum can give rise to "purposeful" actions in the sufferer's non-
dominant hand (an individual who is left-hemisphere-dominant will experience
the left hand becoming alien, and the right hand will turn alien in the person with
right-hemisphere dominance) as well as a problem termed "intermanual conflict"
in which the two hands appear to be directed at opposing purposes, whereas
unilateral injury to the brain's frontal lobe can trigger reaching, grasping and other
purposeful movements in the contralateral hand. With anteromedial frontal lobe
injury, these movements are often exploratory reaching movements in which
external objects are frequently grasped and utilized functionally, without the
simultaneous perception on the part of the patient that they are "in control" of
these movements. Once an object is maintained in the grasp of this "frontal
variant" form of alien hand, the patient often has difficulty with voluntarily
releasing the object from grasp and can sometimes be seen to be peeling the
fingers of the hand back off the grasped object using the opposite controlled
hand to enable the release of the grasped object.

A distinct "posterior variant" form of alien hand syndrome is associated with

damage to the posterolateral parietal lobe and/or occipital lobe of the brain. The
movements in this situation tend to be more likely to withdraw the palmar surface
of the hand away from environmental contact rather than reaching out to grasp
onto objects to produce palmar tactile stimulation, as is most often seen in the
frontal form of the condition. Alien movements in the posterior variant of the
syndrome also tend to be less coordinated and show a coarse ataxic motion
during active movement that is generally not observed in the frontal form of the
condition. The alien limb in the posterior variant of the syndrome may be seen to
'levitate' upward into the air and away from contact surfaces. Alien hand
movement in the posterior variant may show a typical posture, sometimes
referred to as a 'parietal hand' or 'instinctive avoidance reaction' (a term
introduced by neurologist Derek Denny-Brown), in which the digits move into a
highly extended position and the palmar surface is pulled back away from
approaching objects. The 'alien' movements, however, remain purposeful and
goal-directed, a point which clearly differentiates these movements from other
forms of involuntary limb movement (e.g., athetosis, chorea, or myoclonus). In
both the frontal and the posterior variants of the alien hand syndrome, the
patient's reactions to the limb's apparent capability to perform goal-directed
actions independent of conscious volition is similar. In both of these variants of
alien hand syndrome, the alien hand emerges in the hand contralateral to the
damaged hemisphere.
Patients thus will often indicate that the apparently purposeful movements of the
alien hand are "wayward" or "disobedient," in that they are not being generated
through the exertion of their own voluntary will or directed toward goals that have
been consciously produced, but, instead, the alien hand appears to behave
independent of conscious will, effectively "on its own." The alien hand is directed
toward goals of which the patient is not consciously aware. The alien hand may
even engage in socially inappropriate behavior in a public venue causing
significant embarrassment and distress (Ong Hai & Odderson, 2000). Patients
may react with dismay and concern at the ability of the hand to perform
purposeful actions that are independent of their own conscious sense of control
over the movement, a phenomenon termed "auto-criticism."

Alternatively, they may attribute the forces initiating and controlling these
purposeful movements to some external being that is somehow "alien" to their
self-perceived persona. For example, a particularly religious woman with alien
hand syndrome, when asked who or what was actually controlling the alien
movements of her hand if she was not, replied that "God must be doing all of
that." Some patients choose to "personify" the hand and dissociate themselves
from the behavior of the hand by giving it a proper name and attributing to it a
separate and distinct personality and personhood. They may choose to "hold
back" these unwanted, bothersome "alien" movements and behaviors by
grasping and constraining the "wayward" hand with the controlled contralateral
hand, an action that has been termed "self-restriction" or "self-grasping." Such
alien movements and behaviors can also be seen in progressive degenerative
diseases that produce a process of steady systematic disintegration of motor
control circuitry within the central nervous system, such as Creutzfeldt-Jakob
Disease, and corticobasal degeneration.

Explanatory theories
The common emerging factor in alien hand syndrome is that the primary motor
cortex controlling hand movement is isolated from Premotor cortex influences but
remains generally intact in its ability to execute movements of the hand. A very
recent fMRI study looking at the temporal sequence of activation of components
of a cortical network associated with voluntary movement in normal individuals
demonstrated "an anterior-to-posterior temporal gradient of activity from
supplemental motor area through premotor and motor cortices to the posterior
parietal cortex" (Kayser et al. 2009). Therefore, with normal voluntary movement,
the emergent sense of agency appears to be associated with an orderly
sequence of activation that develops initially in the anteromedial frontal cortex in
the vicinity of the supplementary motor complex on the medial surface of the
hemisphere prior to activation of the primary motor cortex. A recent fMRI study
conducted by McGill neurologist Elena Dugan examining the difference in
functional brain activation patterns associated with alien as compared to non-
alien 'volitional' movement in a patient with alien hand syndrome found that alien
movement involves isolated activation of the contralateral secondary motor
cortex, while non-alien movement involved the activation of primary motor cortex
in concert with frontal and parietal association cortex presumably involved in a
cortical network generating premotor influences on the primary motor cortex
(Assal et al. 2007).

It is theorized that alien hand syndrome results when disconnection occurs

between different parts of the brain that are engaged in different aspects of the
control of bodily movement. As a result, different regions of the brain are able to
command bodily movements, but cannot generate a conscious feeling of self-
control over these movements. As a result, the "sense of agency" that is normally
associated with voluntary movement is impaired or lost. There is thus a
dissociation between the process associated with the actual execution of the
physical movements of the limb and the process that produces an internal sense
of voluntary control over the movements, with this latter process thus normally
creating the internal conscious sensation that the movements are being internally
initiated, controlled and produced by an active self. Recent studies have
examined the neural correlates of emergence of the sense of agency under
normal circumstances (Spengler, et al. 2009). This appears to involve consistent
congruence between what is being produced through efferent outflow to the
musculature of the body, and what is being sensed as the presumed product in
the periphery of this efferent command signal. In alien hand syndrome, the neural
mechanisms involved in establishing that this congruence has occurred may be
impaired. This may involve an abnormality in the brain mechanism that
differentiates between "re-afference" (i.e., the return of kinesthetic sensation from
the self-generated 'active' limb movement) and "ex-afference" (i.e., kinesthetic
sensation generated from an externally-produced 'passive' limb movement in
which an active self does not participate). This brain mechanism is proposed to
involve the production of a parallel "efference copy" signal that is sent directly to
the somatic sensory regions and is transformed into a "corollary discharge," an
expected afferent signal from the periphery that would result from the
performance driven by the issued efferent signal. The correlation of the corrollary
discharge signal with the actual afferent signal returned from the periphery can
then be used to determine if, in fact, the intended action occurred as expected.
When the sensed result of the action is congruent with the predicted result, then
the action can be labelled as self-generated and associated with an emergent
sense of agency. If, however, the neural mechanisms involved in establishing
this sensorimotor linkage associated with self-generated action are faulty, it
would be expected that the sense of agency with action would not develop.

One theory posed to explain these phenomena proposes that the brain has
separable neural "premotor" or "agency" systems for managing the process of
transforming intentions into overt action. An anteromedial frontal premotor
system is engaged in the process of directing exploratory actions based on
"internal" drive by releasing or reducing inhibitory control over such actions.
Damage to this system produces disinhibition and release of such actions which
then occur autonomously. A posterolateral temporo-parieto-occipital premotor
system has a similar inhibitory control over actions that withdraw from
environmental stimuli as well as the ability to excite actions that are contingent
upon and driven by external stimulation, as distinct from internal drive. These two
hemispheric systems interact through mutual inhibition that maintains a balance
between responding to and withdrawing from environmental stimuli in the
behavior of the contralateral limbs (Denny-Brown, 1956, 1958, 1966). Together,
these hemispheric agency systems form an integrated intrahemispheric agency
system.

When the anteromedial frontal system is damaged, involuntary but purposive

movements of an exploratory reach-and-grasp nature—what Denny-Brown
(1956, 1966) referred to as a positive cortical tropism—are released in the
contralateral limb. When the posterolateral parieto-occipital system is damaged,
involuntary purposive movements of a release-and-retract nature, such as
levitation and instinctive avoidance, are released. Furthermore, each
intrahemispheric agency system has the capability of acting autonomously in its
control over the contralateral limb although unitary integrative control of the two
hands is maintained through interhemispheric communication between these
systems via the projections traversing the corpus callosum at the cortical level
and other interhemispheric commissures linking the two hemispheres at the
subcortical level. Thus, human agency can be thought of as emerging through
the linked and coordinated action of at least four major agency systems, two in
each hemisphere.

The critical difference between the two hemispheres, however, is the direct
connection between the agency system of the dominant hemisphere and the
encoding system based primarily in the dominant hemisphere that links action
production and its interpretation with language. Thus, the overarching unitary
conscious agent that emerges in the intact brain is based primarily in the
dominant hemisphere and is closely connected to the organization of language
capacity. It is proposed that while action precedes linguistic capacity during
development, a process ensues through the course of development through
which linguistic constructs are linked to action elements in order to produce a
language-based encoding of action-oriented knowledge. Through this process of
basically "telling oneself a story" about how an act occurs, a language-based
"action-capable" self is constructed through consistent correlations between
intended actions and subsequent perceived outcomes.

When there is a major disconnection between the two hemispheres resulting

from callosal injury, the language-linked dominant hemisphere agent which
maintains its primary control over the dominant limb effectively loses its direct
and linked control over the separate "agent" based in the nondominant
hemisphere (and, thus, the nondominant limb), which had been previously
responsive and "obedient" to the dominant conscious agent. The possibility of
purposeful action occurring outside of the realm of influence of the conscious
dominant agent, thus can occur and the basic assumption that both hands are
controlled through and subject to the dominant agent is proven incorrect. The
sense of agency that would normally arise from movement of the nondominant
limb now no longer develops, or, at least, is no longer accessible to
consciousness. A new explanatory "story" for understanding the nature of the
inaccessible agent moving the nondominant limb is thus necessitated.

Under such circumstances, the two agents therefore can direct actions in the two
limbs that are directed at opposing purposes although the dominant hand
remains linked to the dominant consciously accessible agent and is thus viewed
as continuing to be under "conscious control" and obedient to conscious will,
while the nondominant hand is no longer "tied in" to the dominant agent and is
thus identified by the conscious language-based dominant agent as having a
separate and alien agency. This theory would explain the emergence of alien
behavior in the nondominant limb and intermanual conflict between the two limbs
in the presence of damage to the corpus callosum. The distinct anteromedial
frontal and posterolateral temporo-parieto-occipital forms of the alien hand
syndrome would be explained by selective injury to either the frontal or the
posterior agency systems within a particular hemisphere, with the alien behavior
developing in the limb contralateral to the damaged hemisphere.

Proposed strategies for treatment

Although there is no known formal (primary) treatment for alien hand syndrome
at this time, the symptoms can be reduced and managed to some degree by
keeping the alien hand occupied and involved in a task, for example by giving it
an object to hold in its grasp. Also, specific learned tasks can restore voluntary
control of the hand to a significant degree. For example, one patient with the
"frontal" form of alien hand who would reach out to grasp onto different objects
(e.g., door handles) as he was walking was given a cane to hold in the alien hand
while walking, even though he really did not need a cane for its usual purpose of
assisting with balance and facilitating ambulation. With the cane firmly in the
grasp of the alien hand, it would generally not release the grasp and drop the
cane in order to reach out to grasp onto a different object. Thus, different
strategies can be employed to reduce the interference of the alien hand behavior
on the ongoing coherent controlled bodily actions of the patient.

Furthermore, in the presence of unilateral damage to a single cerebral

hemisphere, there is generally a gradual reduction in the frequency of alien
behaviors observed over time and a gradual restoration of voluntary control over
the affected hand, suggesting that neuroplasticity in the bihemispheric and
subcortical brain systems involved in voluntary movement production can serve
to re-establish the connection between the executive production process and the
internal self-generation and registration process. Exactly how this may occur is
not well understood, but a process of gradual recovery from alien hand syndrome
when the damage involves a single hemisphere has been reported.

In another approach, the patient is trained to perform a specific task, such as

moving the alien hand to contact a specific object or a highly salient
environmental target, which is a movement that the patient can learn to generate
voluntarily through focused training in order to effectively override the alien
behavior. It is possible that some of this training produces a re-organization of
premotor systems within the damaged hemisphere, or, alternatively, that
ipsilateral control of the limb from the intact hemisphere may be expanded. Yet
another approach involves simultaneously "muffling" the action of the alien hand
and limiting the sensory feedback coming back to the hand from environmental
contact by placing it in a restrictive "cloak" such as a specialized soft foam hand
orthosis or, alternatively, an everyday oven mitt. Of course, this then limits the
degree to which the hand can participate in addressing functional goals for the
patient. Theoretically, this approach could slow down the process through which
voluntary control of the hand is restored if the neuroplasticity that underlies
recovery involves the exercise of voluntary will to control the actions of the hand
in a functional context.

In popular culture

In Stanley Kubrick's 1964 movie, 'Dr. Strangelove', the eponymous character

played by Peter Sellers is shown to be suffering from Alien Hand
Syndrome.

It is also shown as a vital symptom in 'Both Sides Now', an episode from the
5th season of House MD.
The film Idle Hands is very loosely based on the conditions associated with Alien
Hand Syndrome.

_________________________________________________
Isaac’s writing:

It makes sense that newer parts of the brain, in particular, would be

most at ease receiving information in the form of pseudo sense-data,
or "sensory correlates" -- images, sounds, etc. Each part of the brain is
descended, probably, from a small, primitive *whole brain*, which itself
got information only thru sense data.

So when, say, the right hemisphere of an "early human" wanted to tell

the left hemisphere (which was eagerly chasing after a rabbit, down
toward a certain swamp) that Grampa had always said not to go
there... the most effective way to communicate this would be for it to
send an image of Grandpa saying just that.

Grandpa (and grandma, and various chiefs and heroes

and others) would have gradually evolved into Titans
and Gods, perhaps long before people realized that
they had any agency over such visions -- perhaps even
long before they learned that they could construct an
inner mindspace in which to have "visions" which could
be "seen" as separate from the visual field.

they probably learned to distinguish physical world from "spirit world"

long before they even invented the "mental world" of conscious agency
over sensory correlates.
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Isaac’s writing:
When two people are rowing a canoe, each on opposite sides,
they can maintain balance without talking about it by each
making constant little adjustments to their rowing. Neither is
'controlling' the other, but together they're keeping the boat in
control. This is what self-control sometimes feels like to me...