Brain Advance Access published online on December 8, 2003
Brain, doi:10.1093/brain/awh040
© 2003 by Guarantors of Brain
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Article
1 Laboratory of Presurgical Epilepsy Evaluation, Programme of Functional Neurology and Neurosurgery, University Hospitals, Geneva-Lausanne, Switzerland; Functional Brain Mapping Laboratory, Department of Neurology, University Hospital, Geneva, Switzerland; Neurology Clinic, Department of Neurology, University Hospital, Geneva, Switzerland
* Corresponding author. E-mail: olaf.blanke{at}hcuge.ch.
Received 30 June 2003
; revised 22 August 2003
; accepted 22 September 2003
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.
Keywords: out-of-body experience; autoscopy; neurology; body schema; multisensory processing
Out-of-body experience and autoscopy of neurological origin
2 Neurology Clinic, Department of Neurology, University Hospital, Geneva, Switzerland
3 Laboratory of Presurgical Epilepsy Evaluation, Programme of Functional Neurology and Neurosurgery, University Hospitals, Geneva-Lausanne, Switzerland; Functional Brain Mapping Laboratory, Department of Neurology, University Hospital, Geneva, Switzerland
4 Laboratory of Presurgical Epilepsy Evaluation, Programme of Functional Neurology and Neurosurgery, University Hospitals, Geneva-Lausanne, Switzerland
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