Diagnostic Apraxia and Ictal Alien Hand

Alien hand is a strangely behaving hand and occurs in disease of medial frontal lobe and also corpus callosum. When it is with frontal lobe disease, it manifests as groping and hooking with either hand, but callosal lesions produce left-hand abnormalities of varying degrees. Occasionally this phenomenon can be transient as an ictal manifestation. Case 1 is a 20-year-old female who was on treatment for panic and anxiety for 4 years and later noticed strange action by the left hand pushing food plate and notebook when she is using them with the right hand. Case 2 is a 14-year-old boy who presented with episodes of strange situation where his left hand was pushing his right hand into his mouth, and he had no control over it. He bit his right-hand fingers, and on one episode, he was bleeding from his injured fingers, yet he felt someone is making his left hand do this. Both patients had a demonstrable structural lesion. Patients, when they have stereotyped strange behavior with limbs, need to be investigated for organic disease and initiate treatment accordingly.