Useless Hand Syndrome and Astereognosis in Multiple Sclerosis

Abstract

Useless hand syndrome (UHS) by Oppenheim, comprising clumsiness of complex finger movements and loss of manual dexterity, arises from cervical cord lesions in multiple sclerosis (MS) [1]. From Oppenheim’s report, UHS has been attributed to impaired proprioception, resembling the nature of sensory ataxia [1,2]. In fact, T2 MRI showed high cervical lesions (C2-C4), consistently involving the posterior cord at the C3 to C4 level, in all of our patients with MS and UHS. However, I do not necessarily support the above-mentioned mechanism underlying UHS, because UHS was not associated with disturbance of deep sensations in some cases. As reported previously, UHS might be attributable to astereognosis rather than sensory ataxia, suggesting a disorder of sensorimotor integration [3]. While posterior cord lesions cause both of UHS and sensory ataxia, the underlying mechanism appears to differ, at least in part. In this regard, concurrent sensory disturbances may be helpful in elucidating the underlying mechanism of UHS. In all of our patients, stereognosis was most severely disturbed, whereas disturbance of other combined sensations such as two-point discrimination and graphesthesia ranged from severe to moderate. Combined sense was not necessarily impaired in parallel with deep sense.