Semiologic value of ictal autoscopy

Purpose: Autoscopy is a pathologic perception of one's body or one's face image within space, either from an internal ("as in a mirror") or from an external ("out-of-body experience") point of view. Among various psychiatric and neurologic disorders, partial epilepsy is the main etiology. However, the significance of this rare ictal symptom remains controversial. We report this phenomenon in three epilepsy patients and discuss its semiologic value and neuropsychological significance. Methods: Interictal EEG and/or video-EEG monitoring was performed, as well as neuropsychological examination and cerebral magnetic resonance imaging (MRI). Results: The three patients had a lesion involving, or limited to, the right parietal region on cerebral MRI. All three patients experienced autoscopy associated with other ictal signs supporting a right parietal lobe origin of seizures. In one patient, seizure origin was documented with video and surface EEG ictal recordings. Conclusions: Autoscopy was shown to have an ictal mechanism and was associated with seizures arising from the nondominant parietal region. We hypothesize that ictal autoscopy may result from disruption of the normal integration of body representation.