Elsevier

Cortex

Volume 46, Issue 8, September 2010, Pages 1037-1042
Cortex

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Epileptic feeling of multiple presences in the frontal space

https://doi.org/10.1016/j.cortex.2010.02.002Get rights and content

Abstract

We describe the case of a patient who during a simple focal epileptic seizure due to vascular cerebral sequelae, reported the paroxysmal convincing feeling of the presence of several familiar persons in her peripersonal and extrapersonal space. Because the patient reported sensing multiple presences and recognizing them as family members, her case appears to contradict the hypothesis that the feeling of a non-existent human presence is an autoscopic phenomenon involving the neural “reduplication of the body”. As an alternative hypothesis, I propose that the feeling of a non-existent presence may be only a hallucination of an ordinary “perception of the presence of another”. Otherwise, the closest presence was felt in front of the patient, without lateralization in one hemispace, suggesting the importance to take into account other spatial dimensions than the left/right dimension, such as the front/back dimension, in the feeling of a presence. Illusory perceptive phenomena could participate in future in better understanding brain regions involved in the front/back dimension of the space perceptive representation.

Introduction

The “feeling of a presence” refers to the illusion that somebody is close by although nobody is around (Brugger et al., 1996, Critchley, 1950, Critchley, 1955, Jaspers, 1913, Lhermitte, 1939). It is defined as the convincing feeling that there is another person close by without the patient actually being able to see that person (Blanke et al., 2003, Brugger et al., 1996) and was initially described by Karl Jaspers as “leibhafte Bewusstheit” (Jaspers, 1913). Later authors have named this experience “hallucination du compagnon” (Lhermitte, 1939), idea of a presence (Critchley, 1950), or more recently “feeling of a presence” (Blanke et al., 2003, Brugger et al., 1996). This experience of feeling another human person close by is often described as highly realistic and vivid, but may also be experienced as dreamlike and ephemeral. Although the patients do not experience seeing the “presence,” they are convinced of the presence of another person and can classically describe its spatial localization very accurately (Brugger et al., 1996, James, 1961). The “presence” is almost always experienced in peripersonal space, and most often less than 1 m from the patient's body (Blanke et al., 2003; Brugger et al., 1996) and some patients may also mention a psychological affinity with the “presence” (Brugger et al., 1996, Critchley, 1955), or that the presence has the same body position as the patient (Blanke et al., 2003, Brugger et al., 1996, Engerth and Hoff, 1929, Jaspers, 1913). These latter points have led most previous authors to consider the feeling of a presence as a disorder of own body perception (Blanke et al., 2003, Brugger et al., 1997, Brugger et al., 1996; Critchley, 1955, Hécaen and Ajuriaguerra, 1952, Lhermitte, 1939, Lippman, 1953, Lukianowicz, 1960, Menninger-Lerchenthal, 1935, Williams, 1956). The present paper reports the case of a patient who presented a feeling of multiple presences that she “recognized” as being some of her family members. This questions the hypothesis of an illusory reduplicative phenomenon involving the self. Another interesting element was the absence of strict spatial lateralization of the feeling of presences that underlines that the characterization of the side of the hemispace in which the presence(s) is (are) felt does not constitute a core feature and is not clearly correlated to a lateralized brain origin.

Section snippets

Methods

The case of a patient who during a simple focal epileptic seizure due to vascular cerebral sequelae, reported the paroxysmal convincing feeling of the presence of several familiar persons in her immediate peripersonal and extrapersonal space, is presented. The connections between the feeling of a presence and autoscopic phenomena, particularly polyopic “heautoscopy” characterized by the seeing of several doubles and/or family members in extrapersonal space (Blanke et al., 2008, Brugger et al.,

Results

A 62-year-old right-handed woman of normal psychiatric history presented a simple focal epileptic seizure including a complex sensation characterized by feeling the presence of several members of her family in the immediate environment, associated with paresthesia of the right hemibody (excluding the face). The feeling of presences and the paresthesia (numbness) appeared concomitantly and lasted in total several minutes. The episode occurred while she was sitting alone on the sofa of her living

Discussion

We describe here the case of a patient who presented the feeling of presence of several familiar people due to a simple focal seizure of left hemispheric origin, given the associated paresthesia in the right hemibody. According to the lateralized paresthesia and the neuroradiological data, a left insular origin is likely. The very pleasant emotional component of the feeling of presences may also support an insular involvement, given the known role of the insula in the processing of emotions (

Acknowledgements

I thank Dr Isabelle Viaud-Delmon (IRCAM, Paris), Dr Olaf Blanke (EPFL, Lausanne) and Dr Peter Brugger (Department of Neurology, Zürich) for critical reading of a first draft of the manuscript, and Jim Schnabel (science journalist, Maryland, USA) for suggestions regarding hypothetical mechanisms of the feeling of a presence.

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