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Letter to the Editor
Out-of-body experience as a manifestation of epilepsy
Experiencia extracorporal como manifestación de epilepsia
Eduardo Rubio Nazabala,
Corresponding author
eduardo.rubio.nazabal@sergas.es

Corresponding author.
, Purificación Álvarez Pérezb, Lorena Valdés Aymericha
a Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
b Centro de Salud Adormideras, A Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Autoscopic phenomena &#40;AP&#41; are complex hallucinations of body perception during which the patient experiences a visual duplication of his or her own body in space&#46; AP as a symptom of epileptic seizures has rarely been described&#46;</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&#46; He had been diagnosed with epilepsy at the age of 17&#44; secondary to a right atrioventricular ganglioglioma&#44; and underwent surgery to remove the lesion&#46; The patient was treated with carbamazepine until the age of 19&#44; when it was discontinued as he remained seizure-free&#46; He came to the clinic because&#44; after years without seizures and without treatment&#44; he had started having them again&#46; These were described as if his chest was being squeezed&#44; accompanied by a sensation of high body temperature&#44; difficulty breathing&#44; paraesthesia in the hands&#44; and a perceived decrease in interaction with the environment&#46; Sometimes the sensation increased in intensity and the patient had the perception that he was leaving his body&#44; moving away from it in a backward and upward direction&#44; seeing himself from a height of &#177;3<span class="elsevierStyleHsp" style=""></span>m&#44; seeing his image and his surroundings&#46; He was able to perceive colours and distinguish the people who were with him from a backward and upward position&#46; Witnesses tell him that at this point he was disconnected from his environment&#46; After this vision of his image and environment&#44; the patient presented with generalised tonic-clonic seizures &#40;GTCS&#41; and the next thing he remembered was being surrounded by people who told him that he had seizures&#44; myalgia and the need for restful sleep&#46; Whenever he had AP&#44; the episode ended in GTCS&#46; He described these episodes as similar to those he had experienced in his teens&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the complementary studies&#58; the blood tests were normal&#44; the electroencephalogram &#40;EEG&#41; showed sporadic sharp waves in the posterior temporal and temporal region of the right cerebral hemisphere&#46; The brain magnetic resonance imaging &#40;MRI&#41; 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&#46; After gadolinium injection&#44; no pathological enhancements suggesting tumour recurrence-residue are identified&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Treated with eslicarbazepine at a dose of 1&#44;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; he did not experience any further seizures&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">APs can be classified into three types&#58; out-of-body experiences &#40;OBEs&#41; &#40;the subject observes his own body from above and his self-awareness is outside the physical body&#41;&#44; autoscopy or perception of the body as a mirror &#40;here self-awareness resides in the physical body&#41; and heautoscopy &#40;represents an intermediate state by shifting or fluctuating the location of self-awareness between the physical and non-real body&#44; in which the patient may believe that there is a double of himself&#41;&#46; In general&#44; OBEs are described as unpleasant or fearful feelings&#44; with a high degree of reality&#46; They are accompanied by symptoms of depersonalisation&#44; usually lasting seconds or minutes&#44; the scene is described as three-dimensional and may be accompanied by floating sensations&#44; auditory hallucinations or vibratory illusions&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> OBEs have been associated with lesions at the temporoparietal junction&#46; The real body and the world are viewed from the perspective of a duplicate body that is in a higher position&#46; It is currently postulated that APs are the result of a failure in the integration&#44; at the level of the temporo-parieto-occipital junction&#44; of spatial perception &#40;afferents from the visual cortex&#41; and somatic self-perception &#40;proprioceptive and interoceptive sensory afferents from the parietal sensory cortex and afferents from the vestibular cortex&#41;&#46; AP would be a multisensory integration disorder due to a conflict between visual cues&#44; proprioception and touch&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological causes such as epilepsy&#44; migraine&#44; infections&#44; vascular or neoplastic pathology<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> and extra-neurological causes such as psychiatric pathology &#40;schizophrenia&#44; depression&#44; dissociative disorders&#41; have been described as causes of AP&#59; it has also been reported in patients in near-death situations or under the effect of drugs or general anaesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;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&#46; Its knowledge can help us to establish an appropriate diagnosis and treatment&#46;</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&#46;</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&#46;</p></span></span>"
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Article information
ISSN: 23870206
Original language: English
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