Preliminary evidence for a fronto-parietal dysfunction in able-bodied participants with a desire for limb amputation
BACKGROUND: Reports of able-bodied participants with the persisting desire for limb amputation raise legal and ethical questions that are partly due to insufficient empirical knowledge about the condition. Here, we searched for potential neurological mechanisms in participants with desire for limb amputation in order to help develop adequate nosological classifications, diagnosis, and treatment. METHODS: Semi-structured interviews were carried out with 20 participants who self-identified themselves as able-bodied individuals desiring amputation of a limb. RESULTS: The results suggest that amputation desire is not unspecific, but in most cases specific for a circumscribed part of the body. Most frequently affected was the leg, mostly on the left, non-dominant side. Left-sidedness and limb specificity was associated with elementary and complex somatosensory disturbances of the affected limb akin to those reported by neurological patients. The most frequent neurological co-morbidity was migraine headache. CONCLUSIONS: These results document the existence of an unusual condition in able-bodied participants characterized by a person's desire for the amputation of one or more particular limbs. Left-sidedness, limb specificity and somatosensory disturbances of the affected limb are suggestive of abnormal brain mechanisms in right fronto-parietal cortex. Based on this association we suggest that desire for limb amputation may be conceptualized as asomatognosia due to disturbed integration of multi-sensory information of the affected body parts into a coherent cerebral representation of the own body. This suggestion has to be regarded with caution as we did not perform any neurological examination.