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= Asomatognosia = Asomatognosia: (noun  aso·ma·tog·no·sia  \ ¦āˌsōməˌtägˈnōzh(ē)ə \)

Introduction
Asomatognosia is identified as lack of body recognition. The patient feels that a body part is missing or has disappeared from his or her awareness. Asomatognosia is a neurological disorder caused by a physiological damage to the brain structure, generally to the parietal lobe or a significant medial frontal damage in the right hemisphere. For example, it may surface at the time of an epileptic seizure thus, making it a rare and transitory symptom.

Asomatognosia has been recorded to arise primarily in the left limb of the body, and frequently it accompanies hemispatial neglect. Generally, the mistake of misidentification can be rectified if the identification of the limb is indicated to the patient or if the patient track the association of the left limb up to the shoulder.

Asomatognosia can occur with Anosognosia a form of deficit of self-awareness in which patients are unaware of their disability.

Cause
Even though empirical data for asomatognosia are rare, the findings show that asomatognosia can be corrected by touching the missing limb or by making the patient look at it, indicating a multisensory process in awareness and manifestation of body parts. This also suggests the significance of visual examination of one’s own body to detect somatosensory stimuli for body perception.

An outcome can be found based on the evidences of neuroimaging, clinical and neuropsychology that the posterior parietal cortex and premotor cortex are linked to the coding of the disorder, since the neurons share similar characteristics, it is possible that a hindrance to either area, specifically the right hemisphere, can lead to a pathological development of a disorder.

Asomatognosia is caused by a brain injury which can in both ways have a positive effect or a negative effect on behaviour. The positive effect are additional behaviours that surface after the injury has taken place. These involve delusions or behaviours that can produce misrepresentation of premorbid tendency, for instance the use of metaphorical language. In comparison to the positive effects of a brain lesion, the negative effects are those which the person cannot experience or perform after the brain lesion. These behavioural deficits consist of paralysis, sensory loss, and hemispatial neglect in asomatognosia, creating a confused and unstable situation for the patient. These negative effects make it difficult for the patient to understand whether the limb is theirs or not. The patient ‘feels’ that the limb no longer belongs to him or her.

Asomatognosia is generally detected in chronic left hemispatial neglect. Although it can be followed by somatoparaphrenia: patient refuses to the ownership of an arm or whole side of  his or her body.

Diagnosis
Currently for asomatognosia disorders there are no standardized methods of assessment. Nevertheless, research and data collected, present number of characteristic which are required to be considered while conducting a clinical examination. During the assessment of asomatognosia it is important to modify individually each assessment for all patients due to the complex and unexpected character of this disorder.

It is advised to diagnose as soon as possible, since the characteristics of asomatognosia exist in an acute phase and resolve in the consecutive days. Frequently, detection of asomatognosia rely upon the patient readiness to report their experience regarding their body to the examiner. Hence, it is recommended to have a positive relationship with the patient so that they do not hesitate in the fear of being labelled ‘crazy’. It is important to differentiate between metaphorical statements “my arm seems like a dead animal” and wholly delusional statements “there was a dead arm in my bed tonight”. Halligan et al. (1995) emphasized on this feature between use of simile (which they prefer to ‘‘metaphor’’) and factive mode.

While assessing it is extremely important to avoid providing responses to the patient, so that the patient gives a spontaneous report without any external alterations. Circumstantial aspect should be documented thoroughly. For example, the positioning of the examiner either on the left or right side of the patient can alter the response during the assessment.

A complete recording of asomatognosia should contain the information about the patient include past neurological or psychological assessments. It is important to conduct neuroimaging. An accurate description and transcripts of the alteration of bodily awareness. As well as gathering information about the associated disorders. Self-drawing on how they witnessed themselves during the alteration, with or without the use of mirrors. Duration of the disorder is vital for diagnostic and research purpose.

Assessment tests
Some researchers have accepted Bisiach’s scale for anosognosia to measure asomatognosia. .

Another method called ‘‘fluff test’’, is an assessment where the patient is blindfolded, and cotton balls are spread on the affected side of the patient’s body, and at the time of removing the blindfold the patient is asked to detect and take off all the cotton balls.

Probably the best technique to identify the patient’s negligence to their body is by paying attention on how they behave in their day to day activities. Asomatognosia patient can also be asked to act out using one’s hand gestures such as combing or shaving.

Another test that can be applied is the use of mirrors. Verret and Lapresle in 1978, stated that a woman with right-hemisphere damage disowned her left limb upon direct visual connection. However, she would recognize that it was her arm when looking at its image in a mirror.

Treatment
Asomatognosia is a transient disorder occurring generally after a stroke, epilepsy or a damage to the right hemisphere. Therefore, regarding treatment there are no specific methods to treat asomatognosia.

Asomatognosia has the tendency to recover automatically over the course of acute period. The duration of asomatognosia can range from few hours, occasionally even for minutes or seconds in ictal or paroxystic cases, to chronic conditions persisting for months. Therefore, the suggested procedure regarding asomatognosia patients are same in association for patients suffering from right hemispatial neglect. Physiotherapeutic methods used for the plegic limb, like constraint-induced movement therapy, has also proven to be effective for associated non-motoric disorders.

To obtain an enhanced understanding of asomatognosia disorder, researchers have been developing various treatment proposals, suggesting alternatives for bettering of asomatognosia.
 * The first approach is a vestibular caloric stimulation. It has been shown to momentarily disrupt hemi neglect and somatoparaphrenia. This process consists of submerging the contralesional external ear canal with cold water for 1minute (60mL,20◦C). The outcome is frequently dramatic and may completely remove for a few minutes a chronic anosognosia, hemineglect, or somatoparaphrenia.
 * The second approach is visual adaptation to prismatic deviation which has demonstrated in being a reassuring proposal for hemineglect. This method focuses on patients wearing specific lenses that induces an alteration of the visual field toward the ipsilesional side. In the course of this time, they gradually adjust to the alteration, for example by correcting motor activity in a pointing exercise toward the contralesional side. Following the removal of the prismatic lenses, an after-effect happens in which the pointing errors are aimed toward the contralesional side, thereby relieving unilateral spatial neglect for a few hours or few weeks. This method has proven to also reduce temporarily representational neglect and somatosensory function, like sensitivity and proprioception.
 * Third approach which can be utilized to explore the effects of indirect visual assessments or modality conflicts on asomatognosia. Visual assessments have proven to improve hemiparesis, cause illusory activities, and reduce sensory thresholds, additional research using mirrors should be motivated to gain knowledge and possibly enhance bodily awareness.

Case Study
A 36 years old married woman started experiencing clinical problems from the age of 5, she would unexpectedly get fever, headaches, generalized tonic-clonic seizures. By the age of 9, she expressed seeing colourful lights which came in to the inferior as well as the temporal part of her left eyeball it would last for hardly any seconds. At age 16, she exhibited a strange episode in connection to identifying part of her own body. She suddenly felt it didn’t belong to her. A minute after that, she experienced a seizure. She had a recurrent episode when she was 28, and from then on, she has endured it for a short time but it was frequent. This episode would manifest two times during a month plus it would lasts for a moment to minutes. She visited the Epilepsy Clinic at the National Institute of Neurology and Neurosurgery in Mexico City cause of various ictal disturbances, along with distorted vision in the form of metamorphopsia, visual hallucinations, as well as asomatognosia. Even though the electroencephalogram (EEG) was normal, CT and Magnetic resonance imaging (MRI) studies exposed the existence of a scared tissues equivalent to neurocysticercosis based in the right occipitotemporal cortex. Therefore, this case indicated that ictal asomatognosia as a rare but definite localisation of epileptic episode. Even though the epileptogenic injury was situated in the occipitotemporal area of the brain, the right parietal hypometabolism discovered through PET imaging ought to have a connection with asomatognosia.