lobe epilepsy with relevance to OBE. This relationship is important in regard to the quality of the paroxysmal auras occurring in complex partial seizures. These auras precede a full epileptic fit and its attendant loss of consciousness. Pre- convulsive auras derive from the temporo-parietal lobe, and their content reflects heavily on its role in body-image construction. Disorders of body- image10 typically involve corporeal transformations or displacement, either absence illusions of a phantom limb, the presence of additional supernumerary phantoms, or heautoscopic experiences. Experientially, these auras comprise integrated visual, sensory, auditory, vestibular and somaesthetic components which variously derive from the initial spread of electrical discharges passing through the temporo-parietal and occipital junctional zones of the cerebral cortex. Their phenomenological identity to ECE is very hard to dismiss.
Epileptic auras of this type have an important psychological impact. They are extremely real and veridical, compelling in their effects, and firmly tied to the personal life history and memories of each subject. The affective compo- nent, presumably deriving in part from deep mesial structures (hippocampus and amygdala), is a further dramatic accompaniment. The entire episode becomes a unified, subjective experience. Nevertheless, like dreams and many ECE, ‘time’ is invariably distorted, so that there is no real evolution in the narrative event recalled, since the experience ‘goes nowhere’.11Some cases12 describe vestibular components to their auras—of twisting or turning, being pulled or pushed to one side, while during intra-operative electro-cortical stimulation, patients sense they are rolling off the table or experiencing other spatial displacements of torso or limb. The following quoted excerpts illustrate well the generalizations given above:13
First, a young lady with a right posterior temporal lobe focus who sustained concussion and mild brain injury following a road traffic accident. Following the original impact, she was unconscious for two hours and amnesic for the preceding 24 hours:
10
Lunn V, Acta Psychiatr (Scand) 46 (Suppl 219): 118 125, 1970; Devinsky O, Feldmann E, Burrowes K, Bromfield E, Arch Neurol 46: 1080 1088, 1989; Epstein A, Arch Neurol 16: 613 619, 1967; Halligan P, Cogn Neuropsychiatr 7: 251 268, 2002; Halligan P, Marshall J, Wade D, J Neurol Neurosurg Psychiatr 56: 159 166, 1993; Ionasescu J, Acta Psychiatr Neurol (Scand) 35: 171 181, 1960.
11
Halligan P, Marshall J, Ramachandran V, Cogn Neuropsychol 11: 459 477, 1994; Gloor P, Brain 113: 1673 1694, 1990.
12 Salanova V, Andermann F, Rasmussen T, Olivier A, Quesney L, Brain 118: 607 627, 1995;
Blanke O, Perrig S, Thut G, Landis Th, Seeck M, J Neurol Neurosurg Psychiatr 69: 553 556, 2000.
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[I] left my body and saw it from above that it was lying in a pool of blood in the car. Then I got up, walked around the car, and began banging on the driver’s window. [I saw] a man who instructed me to get back into the car. [Then] the voice of an older [unrecognized] man [said]: ‘Don’t go. Come back and have a child.’
An eye-witness could not corroborate any of this hallucinatory confabula- tion. One month later she had another aura in which the same man’s voice told her that he wanted to take her away from her body. Subsequent auras involved her seeing her own body, dressed in similar clothes, but appearing motionless.
Second, a 29-year-old man with seizures since the age of twelve felt as though he was ascending to the corner of the room, from where he could look down on his body. Although clothed identically, his hair was always combed, even if he knew that was not the case, while the aura continued. With his body motionless below, his ‘mind above’ was free to move around the house and view family members in other rooms. Third, a 35-year-old woman with a long history of absences and tonic-clonic convulsions, was alone in a hotel room. During a seizure she fell between two adjacent beds and became entangled with the bedclothes as her limb thrashing movements continued. Then:
[I] saw a light move from my body on the floor. It lit up the room, and rested up in the corner. Somehow I became the light source up above. [I] looked down and saw [my] body, jerking in all four extremities, tangled up in the sheets. A man’s voice then said to me: ‘Relax, relax, you’re gonna smother if you don’t’: I watched the whole episode as if I were at the movies. Then [my] body on the floor woke up, the voice stopped and I felt [myself] slip back into my body.
Finally, a 41-year-old woman developed complex partial seizures in her twenties. She experienced being out-of-body as though her consciousness was hovering in the upper corner of the room. An associated sense of religious ecstasy involved her talking to God and feeling she was in His presence. Other patients with various pathologies, including temporal lobe epilepsy, reported feelings of sensing another (invisible) presence.14One example15is of a male computer operative with a six-year history of de´ja` vu experiences due to a cerebral tumour (right temporal lobe astrocytoma). After its removal, he reported sensations either of carrying an unidentified object, or of another person standing behind him. These episodes occurred several times a day, but further follow-up details were not given.
14 Brugger and Regard 1997; Brugger P, Regard M, Landis Th, Neuropsychiatr Neuropsychol
Behav Neurol 9: 114 122, 1996.
15
Ardilo A and Gomez J, Epilepsia 29: 188 189, 1988.
It is quite evident, in perusing these striking accounts of patients with temporal lobe pathology, that, if these narratives were subjected to analysis by a ‘blinded’ judge, there might be difficulty in critically distinguishing them from the narratives recalled by people undergoing an OBE or NDE, whether due to causes physiological, or pathological such as cardiac arrest. Both the experiential phenomenology, and its neurophysiological basis as understood to date, indicate a complex series of differing illusory or hallucinatory, extra-corporeal events. I therefore reiterate the point made above: complaints by writers on the subject of ECE declaring that crisis OBE are experientially different from OBE experienced in other circum- stances or through other pathologies, are weak, unconvincing, and carry little weight.
Additional critical insights into this kind of phenomenology have been highlighted recently.16In this short experimental study, investigative findings are described on a 43-year-old woman who for eleven years had suffered from complex partial seizures emanating from a focus somewhere in her right temporal cortex. As part of her pre-operative assessment, sixty-four subdural electrodes were implanted into her skull and then focally stimu- lated. The outcomes of these stimulations under such conditions evoked reports that she was ‘sinking into the bed’; ‘falling from a height’ or ‘floating’ about 2m above the bed subjacent to the ceiling. Higher stimulatory currents caused her to ‘see myself in bed [from above]. . . but . . . [she] only saw her legs and lower torso’ and felt that ‘they were changing in shape and size’. On another occasion when she thought that her arms were rapidly coming towards her, she took evasive action—that is, her hallucination was perceived as real, despite being conscious and having her eyes open at that time. This is an example of the simultaneous perception of illusory mentation in a conscious subject. Other illusions of body parts moving relative to her trunk were experienced even when her eyes were closed. The authors note the differences between this lady’s ability to see her lower half and arms from those total perceptions elicited by Penfield17when electrically stimulating the temporo-parietal regions of patients’ brains. The responses obtained for the laboratory of Olaf Blanke18 were derived from electrodes overlying the aural/balance/spatial awareness ‘centres’ towards the posterior, superior aspects of the right temporal lobe, but possibly involving the inferior parietal lobules.
16 Blanke O, Ortigue S, Landis Th, Seeck M, Nature 419: 269 270, 2002. 17 Penfield W and Perot P, Brain 86: 595 696, 1963.
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