Common and distinct brain networks of autoscopic phenomena

Objective Autoscopic phenomena (AP) are illusory own body reduplications characterized by the visual perception of a second own body in extrapersonal space, and include three main forms: autoscopic hallucination (AH), heautoscopy (HAS) and out-of-body-experience (OBE). Past research showed that lesions were heterogeneously distributed and affected many different brain regions within and across patients, while small case series suggested that AP lesions converge in temporo-parietal and parieto-occipital cortex. As only few studies investigated each form of AP separately, it remains unknown whether the three AP are characterized by common and distinct brain mechanisms. Methods Here, we applied lesion network analysis in 26 neurological AP patients and determined their common and distinct functional connectivity patterns. Results We report that all localize to a single common brain network at the bilateral temporo-parietal junction, further associated with specific patterns of functional connectivity, defining each type of AP. OBE resulted from a brain network connected to bilateral angular gyrus, right precuneus, and right inferior frontal gyrus, differing from AH with a brain network connected to bilateral precuneus, inferior temporal gyrus, and cerebellum. HAS resulted from a brain network connected to left inferior frontal gyrus, left insula and left parahippocampus. Conclusion The present data identify the temporo-parietal junction as the common core region for AP and show that each form of AP recruits additional specific networks, associated with different sensorimotor and self-related sub-networks.

Distinct illusory own-body perceptions caused by damage to posterior insula and extrastriate cortex

Olaf Blanke, Lukas Heydrich

Recent research in cognitive neuroscience using virtual reality, robotic technology and brain imaging has linked self-consciousness to the processing and integration of multisensory bodily signals. This work on bodily self-consciousness has implicated the temporo-parietal, premotor and extrastriate cortex and partly originated in work on neurological patients with different disorders of bodily self-consciousness. One class of such disorders is autoscopic phenomena, which are defined as illusory own-body perceptions, during which patients experience the visual illusory reduplication of their own body in extrapersonal space. Three main forms of autoscopic phenomena have been defined. During autoscopic hallucinations, a second own body is seen without any changes in bodily self-consciousness. During out-of-body experiences, the second own body is seen from an elevated perspective and location associated with disembodiment. During heautoscopy, subjects report strong self-identification with the second own body, often associated with the experience of existing at and perceiving the world from two places at the same time. Although it has been proposed that each autoscopic phenomenon is associated with different impairments of bodily self-consciousness, past research on neurological patients and the development of experimental paradigms for the study of bodily self-consciousness has focused on out-of-body experiences and the association with temporo-parietal cortex. Here, we performed quantitative lesion analysis in the-to date-largest group of patients with autoscopic hallucination and heautoscopy and compared the location of brain damage with those of control patients suffering from complex visual hallucinations. We found that heautoscopy was associated with lesions to the left posterior insula, and that autoscopic hallucinations were associated with damage to the right occipital cortex. Autoscopic hallucination and heautoscopy were further associated with distinct symptoms and deficits. The present data suggest that the autoscopic hallucination is a visuo-somatosensory deficit implicating extrastriate cortex and is, despite the visual hallucination of the own body, not associated with major deficits in bodily self-consciousness. Based on the symptoms and deficits in patients with heautoscopy and the implication of the left posterior insula, we suggest that abnormal bodily self-consciousness during heautoscopy is caused by a breakdown of self-other discrimination regarding affective somatosensory experience due to a disintegration of visuo-somatosensory signals with emotional (and/or interoceptive) bodily signals. These brain mechanisms are distinct from those described for out-of-body experiences. The present data extend previous models of autoscopic phenomena and provide clinical evidence for the importance of emotional and interoceptive signal processing in the posterior insula in relation to bodily self-consciousness.

2013

Out-of-body experience and autoscopy of neurological origin

Olaf Blanke

During an out-of-body experience (OBE), the experient seems to be awake and to see his body and the world from a location outside the physical body. A closely related experience is autoscopy (AS), which is characterized by the experience of seeing one's body in extrapersonal space. Yet, despite great public interest and many case studies, systematic neurological studies of OBE and AS are extremely rare and, to date, no testable neuroscientific theory exists. The present study describes phenomenological, neuropsychological and neuroimaging correlates of OBE and AS in six neurological patients. We provide neurological evidence that both experiences share important central mechanisms. We show that OBE and AS are frequently associated with pathological sensations of position, movement and perceived completeness of one's own body. These include vestibular sensations (such as floating, flying, elevation and rotation), visual body-part illusions (such as the illusory shortening, transformation or movement of an extremity) and the experience of seeing one's body only partially during an OBE or AS. We also find that the patient's body position prior to the experience influences OBE and AS. Finally, in five patients, brain damage or brain dysfunction is localized to the temporo-parietal junction (TPJ). These results suggest that the complex experiences of OBE and AS represent paroxysmal disorders of body perception and cognition (or body schema). The processes of body perception and cognition, and the unconscious creation of central representation(s) of one's own body based on proprioceptive, tactile, visual and vestibular information-as well as their integration with sensory information of extrapersonal space-is a prerequisite for rapid and effective action with our surroundings. Based on our findings, we speculate that ambiguous input from these different sensory systems is an important mechanism of OBE and AS, and thus the intriguing experience of seeing one's body in a position that does not coincide with its felt position. We suggest that OBE and AS are related to a failure to integrate proprioceptive, tactile and visual information with respect to one's own body (disintegration in personal space) and by a vestibular dysfunction leading to an additional disintegration between personal (vestibular) space and extrapersonal (visual) space. We argue that both disintegrations (personal; personal-extrapersonal) are necessary for the occurrence of OBE and AS, and that they are due to a paroxysmal cerebral dysfunction of the TPJ in a state of partially and briefly impaired consciousness.

Oxford University Press2004

Turning Body and Self Inside Out

Lukas Heydrich

What is the self? This major philosophical question has been considered too complex to be studied in neuroscience. However, during the last 20 years, researchers from different disciplines within the cognitive neurosciences have started investigating the neural correlates of self-consciousness, using a range of behavioural paradigms and functional imaging techniques. Where as many researchers have studied highorder representational aspects of self-consciousness, such as language (i.e. the use of the self-referential pronoun "I" or "Me"), converging evidence suggests that the most basic sense of self, e.g. the sensation that we possess a stable and coherent representation of our body, that we identify with our body and that we perceive the self as being located within the bodily boundaries (e.g. bodily self-consciousness), is due to integration of bodily signals from different exteroceptive sensory modalities (vision, touch, proprioception). Others have highlighted the importance signals related to internal signals (homeostasis, interoception) for self-consciousness. Using lesion analysis, we could demonstrate a causal link between damage to the right temporo-parietal junction and an altered state of bodily self-consciousness, e.g out-of-body experiences. This was confirmed using functional magnetic resonance imaging, multisensory exteroceptive conflicts and virtual reality: if healthy participants perceived themselves as "disembodied", activity in the same cortical region (i.e. temporo-parietal junction) was systematically modulated. Moreover, we were able to demonstrate in a second line of experiments that interoceptive signals can be used to systematically alter bodily self-consciousness and somatosensory processing, extending previous paradigms that focused exclusively on exteroceptive signals. This was strengthened by our finding that the left posterior insula, repeatedly linked to the representation and integration of internal and external bodily signals, is implicated in another state of altered bodily self-consciousness, e.g. heautoscopy. Our results demonstrate that bodily self-consciousness is based on a neural network that represents and integrates both external and internal signals from the body.

EPFL2012