Deficient mental own-body imagery in a neurological patient with out-of-body experiences due to cannabis use

In the present work, we report repeated out-of-body experiences (OBEs) in a patient with tetraplegia and severe somatosensory loss due to multiple sclerosis and predominant involvement of the cervical spinal cord. OBEs were experienced on a daily basis and induced by cannabis treatment that was started for severe spasticity with painful cramps and cloni. In order to investigate the link between OBEs and mental own-body imagery, the patient was asked to imagine himself in the position and visual perspective that is generally reported during OBEs, using front- and back-facing schematic human stimuli. Performance was measured before and after cannabis consumption. First, our data reveal that the patient was less accurate for back-facing than front-facing stimuli. This was found before and after cannabis consumption and is the opposite pattern to what is generally observed in healthy participants and in our control subjects (who did not use cannabis). We refer to this as lesion effect and argue that this relative facilitation for stimuli reflecting the position and visual perspective that is generally reported during OBEs might be due to recurrent and spontaneous own-body transformations during the patient's frequent OBEs. Secondly, we found a cannabis effect, namely a performance improvement in the back-facing condition while performance in the front-facing condition remained unchanged, after cannabis administration. We argue that cannabis administration may interfere with own-body imagery when reflecting the actual body position and only when associated with brain damage. Based on these data we propose an extended neurological model for own-body illusions including multisensory and sensorimotor mechanisms, cannabis consumption, and cortical and subcortical processing.