"Ictal" Alien Hand Syndrome

The alien hand syndrome is rare, occurring with lesions in the mesial frontal lobe area and corpus callosum. We report an unusual presentation of seizures in a 65-year-old woman with a presumed low-grade glioma involving the mesial frontal lobe region, with the "alien hand" seen only during a seizure. Neuropsychological evaluation revealed lateralized cognitive dysfunction consistent with the location of the lesion. There were no interictal indications of disconnection syndrome. The mechanism postulated is disruption of transcallosal motor connections due to the propagating seizure across nondominant motor regions.