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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;160:92-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Dying <span class="elsevierStyleItalic">with</span> or dying <span class="elsevierStyleItalic">from</span> COVID-19: When being able to count is relevant" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "93" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morir con o morir de COVID-19: cuando poder contar es relevante" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1295 "Ancho" => 2515 "Tamanyo" => 177990 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">COVID-19 death-counts (confirmed and suspected) by age group and sex* in residents of the Region of Murcia, 2020.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lluís Cirera, Rafael M. Bañón" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lluís" "apellidos" => "Cirera" ] 1 => array:2 [ "nombre" => "Rafael M." "apellidos" => "Bañón" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622006076?idApp=UINPBA00004N" "url" => "/23870206/0000016000000002/v1_202301190805/S2387020622006076/v1_202301190805/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Out-of-body experience as a manifestation of epilepsy" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "94" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Rubio Nazabal, Purificación Álvarez Pérez, Lorena Valdés Aymerich" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Rubio Nazabal" "email" => array:1 [ 0 => "eduardo.rubio.nazabal@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:4 [ "nombre" => "Purificación" "apellidos" => "Álvarez Pérez" "email" => array:1 [ 0 => "purificacion.alvarez.perez@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Lorena" "apellidos" => "Valdés Aymerich" "email" => array:1 [ 0 => "lorena.aymerich@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud Adormideras, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia extracorporal como manifestación de epilepsia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Autoscopic phenomena (AP) are complex hallucinations of body perception during which the patient experiences a visual duplication of his or her own body in space. AP as a symptom of epileptic seizures has rarely been described.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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 ±3<span class="elsevierStyleHsp" style=""></span>m, 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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Treated with eslicarbazepine at a dose of 1,200<span class="elsevierStyleHsp" style=""></span>mg/day, he did not experience any further seizures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></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"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological causes such as epilepsy, migraine, infections, vascular or neoplastic pathology<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></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"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that they did not receive any funding for this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Out-of-body experience and autoscopy of neurological origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Blanke" 1 => "T. Landis" 2 => "L. Spinelli" 3 => "M. Seeck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/brain/awh040" "Revista" => array:7 [ "tituloSerie" => "Brain." "fecha" => "2004" "volumen" => "127" "numero" => "Pt 2" "paginaInicial" => "243" "paginaFinal" => "258" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14662516" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Common and distinct brain networks of autoscopic phenomena" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Blondiaux" 1 => "L. Heydrich" 2 => "O. Blanke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nicl.2021.102612" "Revista" => array:3 [ "tituloSerie" => "NeuroImage: Clinical." 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"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." "fecha" => "2013" "volumen" => "260" "numero" => "3" "paginaInicial" => "742" "paginaFinal" => "749" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23086176" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000002/v1_202301190805/S238702062200599X/v1_202301190805/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000002/v1_202301190805/S238702062200599X/v1_202301190805/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062200599X?idApp=UINPBA00004N" ]
