振動刺激およびミラーセラピーの併用療法により身体パラフレニアの改善を認めた一例

Benefits of combining vibratory stimulation and mirror therapy on somatoparaphrenia: A case report

要旨：身体パラフレニア（somatoparaphrenia；以下，SP）は，妄想性の誤認や作話，身体の所有感が消失する現象であり，通常右半球の前頭頭頂葉の広範な病変で生じ，左半球損傷では珍しいとされる．今回，右上下肢の非所属感，他人帰属化，右上肢の擬人化といったSP症状を訴える50歳代女性を担当した．頭部MRIにて左視床に2cmの血腫と，SPECT画像にて左半球の広範囲に血流欠損を認めた．本事例のSP症状に対し，振動刺激とミラーセラピーの併用療法を行ったところ，非所属感の改善を認めることができた．右上下肢への振動刺激とミラーセラピーの併用療法により身体図式が再構築されたことが，SPの改善につながったのではないかと考える．

　Somatoparaphrenia (SP) is a syndrome involving both a lack of awareness of ownership of a body part and delusional misidentification and confabulation. SP patients usually have large fronto-parietal lesions in the right hemisphere, and SP resulting from left hemisphere lesions is relatively rare. A 50-year-old woman with left thalamic hematoma suffered from feelings of disownership of the right upper and lower extremities. In addition to these feelings of disownership, she complained of a sense of nonbelonging, autoheterosyncisis, and personification of her right upper extremity. Brain magnetic resonance imaging demonstrated a left thalamic hematoma (2cm), and an eazy Z score Imaging System (eZIS) analysis of the single photon emission computed tomography (SPECT) images showed widespread hypoperfusion in the left hemisphere. We performed combination therapy using vibratory stimulation and mirror therapy for the SP of her right upper and lower extremities. She eventually came to recognize the right extremity as her own. Combination therapy using direct sensory input and visual optical illusion of the right limb aid in the reconstruction of the body image resulting in successful treatment of cases of SP.