Anarchic-hand syndrome: ERP reflections of lost control over the right hemisphere

In patients with the callosal type of anarchic-hand syndrome, the left hand often does not act as intended and counteracts the right hand. Reports are scarce about the underlying neurophysiological mechanisms. We report the case G.H. who developed the syndrome after infarction of the left arteria pericallosa. It has been suggested that the syndrome arises out of lacking inhibition from the dominant left hemisphere on the right hemisphere. Yet, in tests of spatial intelligence G.H. performed much better with his "anarchic" left hand than with his dominant right hand, similar to observations commonly reported in split-brain patients. Left-right manual choice responses and event-related EEG potentials to laterally presented stimuli were measured. Asymmetries were evident in G.H.'s behavior and EEG potentials, different from age-matched healthy participants (n=11). His right-hand responses were fast and unaffected by incompatibility with stimulus location, whereas his left-hand responses were variable and accompanied by a large negative central-midline EEG potential, probably reflecting efforts in initiating the response. G.H.'s visual N1 component peaked earlier and was larger at the right than the left side of the scalp, and the P3 component was distinctly reduced at the right side. Both features occurred independent of side of stimulus presentation and side of responding hand. The effort indicated by the midline negativity and the asymmetrically reduced P3 might directly reflect G.H.'s lack of control on his right hemisphere's processing. The faster visual processing of the right hemisphere suggested by the N1 asymmetry might contribute to "anarchic" processing, making the right hemisphere process stimuli before control impulses exert their effect. These neurophysiological results tend to support the split-brain account which assumes that the syndrome arises by the lack of communication between hemispheres that act according to their respective competences.