Out-of-body experience as a manifestation of epilepsy

Rubio Nazabal, Eduardo; Álvarez Pérez, Purificación; Valdés Aymerich, Lorena

doi:10.1016/j.medcle.2022.08.023

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Bañón" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lluís" "apellidos" => "Cirera" ] 1 => array:2 [ "nombre" => "Rafael M." 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AP as a symptom of epileptic seizures has rarely been described.We report the case of a 32-year-old male who came to our clinic with a history of epilepsy. He had been diagnosed with epilepsy at the age of 17, secondary to a right atrioventricular ganglioglioma, and underwent surgery to remove the lesion. The patient was treated with carbamazepine until the age of 19, when it was discontinued as he remained seizure-free. He came to the clinic because, after years without seizures and without treatment, he had started having them again. These were described as if his chest was being squeezed, accompanied by a sensation of high body temperature, difficulty breathing, paraesthesia in the hands, and a perceived decrease in interaction with the environment. Sometimes the sensation increased in intensity and the patient had the perception that he was leaving his body, moving away from it in a backward and upward direction, seeing himself from a height of ±3m, seeing his image and his surroundings. He was able to perceive colours and distinguish the people who were with him from a backward and upward position. Witnesses tell him that at this point he was disconnected from his environment. After this vision of his image and environment, the patient presented with generalised tonic-clonic seizures (GTCS) and the next thing he remembered was being surrounded by people who told him that he had seizures, myalgia and the need for restful sleep. Whenever he had AP, the episode ended in GTCS. He described these episodes as similar to those he had experienced in his teens.In the complementary studies: the blood tests were normal, the electroencephalogram (EEG) showed sporadic sharp waves in the posterior temporal and temporal region of the right cerebral hemisphere. The brain magnetic resonance imaging (MRI) showed post-surgical changes with an area of right temporobasal encephalomalacia which in its deep portion adjacent to the temporal horn communicates with a cystic portion even with an intraventricular site. After gadolinium injection, no pathological enhancements suggesting tumour recurrence-residue are identified.Treated with eslicarbazepine at a dose of 1,200mg/day, he did not experience any further seizures.APs can be classified into three types: out-of-body experiences (OBEs) (the subject observes his own body from above and his self-awareness is outside the physical body), autoscopy or perception of the body as a mirror (here self-awareness resides in the physical body) and heautoscopy (represents an intermediate state by shifting or fluctuating the location of self-awareness between the physical and non-real body, in which the patient may believe that there is a double of himself). In general, OBEs are described as unpleasant or fearful feelings, with a high degree of reality. They are accompanied by symptoms of depersonalisation, usually lasting seconds or minutes, the scene is described as three-dimensional and may be accompanied by floating sensations, auditory hallucinations or vibratory illusions.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> OBEs have been associated with lesions at the temporoparietal junction. The real body and the world are viewed from the perspective of a duplicate body that is in a higher position. It is currently postulated that APs are the result of a failure in the integration, at the level of the temporo-parieto-occipital junction, of spatial perception (afferents from the visual cortex) and somatic self-perception (proprioceptive and interoceptive sensory afferents from the parietal sensory cortex and afferents from the vestibular cortex). AP would be a multisensory integration disorder due to a conflict between visual cues, proprioception and touch.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>Neurological causes such as epilepsy, migraine, infections, vascular or neoplastic pathology<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a> and extra-neurological causes such as psychiatric pathology (schizophrenia, depression, dissociative disorders) have been described as causes of AP; it has also been reported in patients in near-death situations or under the effect of drugs or general anaesthesia.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>With this case we want to underline the existence of this rare phenomenon that can be associated with several entities. Its knowledge can help us to establish an appropriate diagnosis and treatment.FundingThe authors state that they did not receive any funding for this article.Conflict of interestsThe authors declare that they have no conflict of interest." 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"fecha" => "2021" "volumen" => "30" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Out-of-body experiences associated with seizures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Greyson" 1 => "N.B. Fountain" 2 => "L.L. Derr" 3 => "D.K. Broshek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fnhum.2014.00065" "Revista" => array:5 [ "tituloSerie" => "Front Hum Neurosci." "fecha" => "2014" "volumen" => "8" "paginaInicial" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24592228" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Astral projection: a strange out-of-body experience in dissociative disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Mudgal" 1 => "R. Dhakad" 2 => "R. Mathur" 3 => "U. Sardesai" 4 => "V. Pal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.17037" "Revista" => array:4 [ "tituloSerie" => "Cureus." "fecha" => "2021" "volumen" => "13" "numero" => "8" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ictal autoscopic phenomena and near death experiences: a study of five patients with ictal autoscopies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Hoepner" 1 => "K. Labudda" 2 => "T.W. May" 3 => "M. Schoendienst" 4 => "F.G. Woermann" 5 => "C.G. Bien" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00415-012-6689-x" "Revista" => array:7 [ "tituloSerie" => "J Neurol." 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Vol. 160. Issue 2.

Pages 93-94 (January 2023)

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