ArticlePDF Available

Out-of-body experiences associated with seizures

Authors:

Abstract

Alterations of consciousness are critical factors in the diagnosis of epileptic seizures. With these alterations in consciousness, some persons report sensations of separating from the physical body, experiences that may in rare cases resemble spontaneous out-of-body experiences. This study was designed to identify and characterize these out-of-body-like subjective experiences associated with seizure activity. Fifty-five percent of the patients in this study recalled some subjective experience in association with their seizures. Among our sample of 100 patients, 7 reported out-of-body experiences associated with their seizures. We found no differentiating traits that were associated with patients' reports of out-of-body experiences, in terms of either demographics; medical history, including age of onset and duration of seizure disorder, and seizure frequency; seizure characteristics, including localization, lateralization, etiology, and type of seizure, and epilepsy syndrome; or ability to recall any subjective experiences associated with their seizures. Reporting out-of-body experiences in association with seizures did not affect epilepsy-related quality of life. It should be noted that even in those patients who report out-of-body experiences, such sensations are extremely rare events that do not occur routinely with their seizures. Most patients who reported out-of-body experiences described one or two experiences that occurred an indeterminate number of years ago, which precludes the possibility of associating the experience with the particular characteristics of that one seizure or with medications taken or other conditions at the time.
ORIGINAL RESEARCH ARTICLE
published: 13 February 2014
doi: 10.3389/fnhum.2014.00065
Out-of-body experiences associated with seizures
Bruce Greyson1*, Nathan B. Fountain2,LoriL.Derr
1and Donna K. Broshek3
1Division of Perceptual Studies, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
2F.E. Dreifuss Comprehensive Epilepsy Program, Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
3Neurocognitive Assessment Laboratory, Department of Psychiatr y and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville,
VA, USA
Edited by:
Etzel Cardeña, University of Lund,
Sweden
Reviewed by:
Andrea E. Cavanna, Birmingham and
Solihull Mental Health NHS
Foundation Trust, UK
Enrico Facco, University of Padua,
Italy
*Correspondence:
Bruce Greyson, Division of
Perceptual Studies, Department of
Psychiatry and Neurobehavioral
Sciences, University of Virginia
School of Medicine, 210 10th Street
NE, Charlottesville, VA 22902-4754,
USA
e-mail: cbg4d@virginia.edu
Alterations of consciousness are critical factors in the diagnosis of epileptic seizures. With
these alterations in consciousness, some persons report sensations of separating from
the physical body, experiences that may in rare cases resemble spontaneous out-of-body
experiences. This study was designed to identify and characterize these out-of-body-like
subjective experiences associated with seizure activity. Fifty-five percent of the patients in
this study recalled some subjective experience in association with their seizures. Among
our sample of 100 patients, 7 reported out-of-body experiences associated with their
seizures. We found no differentiating traits that were associated with patients’ reports of
out-of-body experiences, in terms of either demographics; medical history, including age
of onset and duration of seizure disorder, and seizure frequency; seizure characteristics,
including localization, lateralization, etiology, and type of seizure, and epilepsy syndrome;
or ability to recall any subjective experiences associated with their seizures. Reporting
out-of-body experiences in association with seizures did not affect epilepsy-related quality
of life. It should be noted that even in those patients who report out-of-body experiences,
such sensations are extremely rare events that do not occur routinely with their seizures.
Most patients who reported out-of-body experiences described one or two experiences
that occurred an indeterminate number of years ago, which precludes the possibility of
associating the experience with the particular characteristics of that one seizure or with
medications taken or other conditions at the time.
Keywords: epilepsy, seizures, out-of-body experience, autoscopy, near-death experience
INTRODUCTION
Alteration and impairment of consciousness are critical factors
in the definition and diagnosis of epileptic seizures. There has
been growing interest in the subjective descriptions of these con-
sciousness alterations in patients with epilepsy as a source of data,
in addition to objective observations of patients’ behavior and
communications and electroencephalographic (EEG) evidence of
altered brain activity (Johanson et al., 2003).
A subjective feature sometimes reported in association with
seizures is the sense of being outside the physical body. Devinsky
et al. (1989) reported that 10 (6.3%) of 158 patients with epilepsy
reported ictal or postictal “autoscopy,” a category that included
both out-of-body experiences (9 cases) and seeing a visual image
of one’s double while one’s center of consciousness remains inside
the body (1 case). Recently, Hoepner et al. (2013) reported 5
patients with ictal autoscopy, 4 of whom reported out-of-body
experiences, and all of whom had an epileptic focus “at the
temporo-parietal junction or its neighboring regions” (p. 742).
Purported out-of-body experiences have previously been associ-
ated with electrical stimulation of the angular gyrus near the right
tempo-parietal junction (Blanke et al., 2002).
This study was designed to identify and characterize reports of
out-of-body experience associated with seizure activity. We com-
pared these reports of out-of-body experience with EEG evidence
of seizure focus, in order to increase our understanding of the role
of neurophysiological factors in such experiences; and with scores
on a standardized measure of epilepsy-related quality of life.
MATERIALS AND METHODS
PARTICIPANTS
Patients attending the University of Virginia’s F. E. Dreifuss
Comprehensive Epilepsy Program were invited by their neurolo-
gists to participate in the study. After providing written informed
consent, patients who agreed to participate were interviewed by
one of us (Bruce Greyson or Lori L. Derr) regarding their recall of
experiences associated with seizures.
We interviewed 100 patients with seizures. We excluded
patients who had psychogenic seizures only, as well as those with
intellectual impairment or psychotic symptoms severe enough to
render their responses unreliable. Patients were obtained non-
consecutively, as time constraints made it impossible to interview
all patients with epilepsy; additionally, those patients who lacked
the intellectual and linguistic capacity to be interviewed were
not invited by their neurologist to participate in the study. The
mean age of the 100 patients interviewed was 39.7 years (SD =
12.8), with a range from 18 to 70. The sample included 51
womenand49men.Themeaneducationlevelofthepatients
was 13.1 years (SD =2.6), with a range from 4 to 19. The 100
patients included 84 Euro-Americans, 14 African Americans, and
2 Latino-Americans.
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |1
HUMAN NEUROSCIENCE
Greyson et al. Out-of-body experiences associated with seizures
PROCEDURE
After soliciting an unstructured narrative description of subjec-
tive experiences associated with seizures, we administered to all
patients interviewed, whether or not they claimed to recall any
subjective experience, the Near-Death Experience (NDE) Scale,
which includes a question specifically asking if they had ever felt
separated from the body. We chose to use the NDE Scale specifi-
cally because it addressed out-of-body experiences, embedded in
a series of questions about other unusual phenomena. Alternative
instruments designed to assess alterations of consciousness, such
as the Ictal Consciousness Inventory (Cavanna et al., 2008), do
not address out-of-body sensations.
The NDE Scale consists of 16 multiple-choice items that
address features commonly reported in NDEs, including cogni-
tive changes, affective changes, purportedly paranormal processes
including a sensation of being “out of the body,” and expe-
riences of transcendence (Greyson, 1983). The NDE Scale has
high internal consistency, split-half reliability, test-retest reliabil-
ity, and correlation with other measures of NDE (Greyson, 1983).
A Rasch rating-scale analysis established that the NDE Scale yields
a unidimensional measure with interval-scaling properties that
differentiates NDEs qualitatively and quantitatively from other
responses to the threat of death (Lange et al., 2004).
Patients were also administered the Quality of Life in Epilepsy
Scale (QOLIE-10), a 10-item Likert-type instrument designed
to screen quality of life in persons with epilepsy (Cramer
et al., 1996).TheQOLIE-10wasdevelopedasabriefinstru-
ment to assess the domains of seizure worry; emotional worry;
energy/fatigue; cognition; physical and mental effects of medi-
cation; driving, social, and work limitations; and overall qual-
ity of life. Factor analysis yielded three factors labeled Epilepsy
Effects (e.g., memory), Mental Health (e.g., depression), and Role
Function (e.g., work limitations). The QOLIE-10 has demon-
strated test-retest reliability, external criterion validity, and dis-
criminant validity (Cramer et al., 1996).
The medical records of participants were examined for data
on age of onset and duration of the seizure disorder, seizure fre-
quency, and epilepsy etiology. EEG recordings were examined for
EEG evidence of anatomic localization and lateralization of the
seizure focus. The International League Against Epilepsy (ILAE)
seizuretype(Dreifuss et al., 1981), and the ILAE epilepsy syn-
drome (Commission on Classification and Terminology of the
International League Against Epilepsy, 1989) were derived from
the medical records.
DATA ANALYSIS
Patients were included in the out-of-body experience group
(“experiencers”) if they either spontaneously described a sense of
leaving the body associated with a seizure, or indicated on the
NDE Scale that they had “clearly left my body and existed out-
side it” in association with a seizure. Those patients who did not
report out of-body experiences associated with their seizures were
designated as the comparison group.
We compared epilepsy clinic patients who reported out-of-
body experiences associated with their seizures and a comparison
group of patients who did not report out-of-body experiences
on various facets of their seizures and neurological history and
evaluation. We included comparisons involving neurophysiologi-
cal data from the patients’ clinic medical records, including their
EEG recordings, to ascertain the anatomic focus of the seizure,
the type of seizure, and the specific epilepsy syndrome; histori-
cal data on age of onset and duration of the seizure disorder, and
maximum number of seizures per month.
RESULTS
SUBJECTIVE EXPERIENCES ASSOCIATED WITH SEIZURES
Of the 100 patients interviewed, 55 were able to recall some
subjective experience associated with their seizures. Of those 55
patients, 29 (53%) reported that they could recall more than
10 seizure-associated subjective experiences, 23 (42%) reported
between 2 and 10 seizure-associated experiences, and 3 (5%)
reported that they could recall only 1 seizure-associated sub-
jective experience. Thirty-nine of those patients (71%) reported
that those experiences occurred during an aura immediately
before their seizures, 30 (55%) reported experiences during their
seizures, and 25 (45%) reported experiences during the pos-
tictal period immediately following their seizures. Percentages
total more than 100% because some patients attributed their
subjective experiences to more than one time period, and
some could not determine when the experiences had occurred.
For these reasons, it was not possible to distinguish pre-
cisely between aural, ictal, and postictal experiences. Most
of these reports of subjective experience consisted of only
brief, fragmentary sensory impressions rather than coherent
narratives.
The kinds of subjective experiences patients reported were pri-
marily changes in emotional state, cognitive changes, other con-
sciousness alterations, sensory distortions, paresthesias, and other
somatic sensations. Emotions, reported by 44 patients, included
feeling scared, anxious, sad, apprehensive, threatened, and feel-
ing pursued; less commonly, patients reported feeling euphoric or
“protected.” Cognitive changes, reported by 40 patients, included
déjà vu, racing thoughts, indecipherable thoughts, confusion, sin-
gle words repeating in one’s thoughts, and flashbacks from child-
hood. Other consciousness alterations, reported by 32 patients,
included feeling tired, sleepy, “spacey,” dazed, fatigued, exhausted,
intoxicated, feeling as if one is “falling into darkness,” and “no
sense of order.
Sensory distortions, reported by 55 patients, included see-
ing flashing lights, wavy lines, insects, geometric colored shapes,
and kaleidoscopic vision, monochromatic vision, and seeing as
if through a film; hearing music, pulsing noises, “a sound like
Rice Krispies,” and hearing voices as if from far away or slowed
down; smelling sulfur, burning, watermelon, ammonia, and pun-
gent spices; and a bad taste in one’s mouth. Paresthesias, reported
by 23 patients, included feeling lightheaded, dizzy, tingling, elec-
tric jolts in the body, a stunned sensation like a nerve block,
facial numbness, feeling “a sugar rush,” “butterflies,” waves of
energy pulsing through the body, and burning sensations. Other
somatic sensations, reported by 31 patients, included headache,
pounding in one’s head, tightness in the head, head swim-
ming, nausea, sweatiness, warmth, coldness, palpitations, feeling
pulled or twisted, feeling one’s energy drained, weakness, and
stomach ache.
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |2
Greyson et al. Out-of-body experiences associated with seizures
FEATURES OF NEAR-DEATH EXPERIENCE
The mean score of all participants on the NDE Scale was 1.72
(SD =1.72), with a range from 0 to 6, with none of the 100
patients meeting the standard criterion of 7 points for NDEs.
The number of patients endorsing each item on the NDE Scale
is presented in Ta b l e 1. The most commonly reported features
in association with a seizure were a sense of being out of the
body and distortion of the sense of time. No patients endorsed
a speeding up of their thoughts, a sense of revelation or sudden
understanding, feeling of joy, sense of cosmic unity or oneness,
increased sensory vividness, apparent extrasensory perception, or
vision of deceased or religious spirits.
REPORTS OF OUT-OF-BODY EXPERIENCE
Of the 100 patients interviewed, none spontaneously reported
out-of-body experiences as part of their open-ended narrative
description of subjective experiences associated with seizures.
However, in their subsequent responses on the NDE Scale, 7
patients reported a sensation of having left their bodies at some
point during a seizure. When asked why they had not mentioned
out-of-body experiences during their open-ended narratives, the
patients commented either that they had forgotten about the out-
of-body sensations until the interviewer mentioned them, or that
they did not think that was what the interviewer had meant by
“experiences associated with seizures.” Note that this figure of
7% represents a lifetime prevalence of out-of-body experiences
associated with seizures, rather than the incidence of out-of-body
experiences with seizures:
(1) A 28-year-old female graduate student with symptomatic
localization-related epilepsy due to periventricular nodular
Table 1 | Frequency of affirmative responses to NDE Scale items
associated with seizures (N=100) .
NDE Scale item Affirmative responses
COGNITIVE FEATURES
Time distortion 7
Life review or panoramic memory 2
Thought acceleration 0
Revelation or sudden understanding 0
AFFECTIVE FEATURES
Overwhelming peace 1
Experience of brilliant light 1
Feeling of joy 0
Sense of cosmic unity or oneness 0
PURPORTEDLY PARANORMAL FEATURES
Out-of-body experience 7
Vision of future events 2
Increased sensory vividness 0
Apparent extrasensory perception 0
TRANSCENDENTAL FEATURES
Experience of another realm or world 3
Experience of a spiritual being or voice 2
Experience of a border or point of no return 1
Vision of deceased or religious spirits 0
heterotopia had both complex partial and simple partial
seizures. She also had Dandy-Walker malformation, Marfan
syndrome, polycystic ovarian disease, and an extra verte-
bra. She reported 2-3 simple partial seizures a week, which
she described as “the world coming in” without attenuation
of consciousness. These events began at age 24 and lasted
about 30 s. She reported about 1 complex partial seizure a
month, which involved staring and inability to speak (i.e.,
she could think of words to say but could not produce mean-
ingful speech) and inability to comprehend written language
(i.e., printed words appeared as gibberish). The complex
partial seizures could last up to 20 min, and were followed
by postictal fatigue or confusion for up to 1–2 h. Her EEG
showed independent bilateral temporal epileptiform spikes
(left greater than right) and left parasagittal spikes. Her MRI
showed bilateral periventricular nodular heterotopia and a
Dandy-Walker malformation.
She reported leaving her body during every complex par-
tial seizure: while her body became immobile, she felt she was
floating above it and could view her body and its surround-
ings from above. However, she reported a dual consciousness
in which, while seeming to hover above her body, she also
remained aware of bodily sensations. She reported that if
someone brushed against her body, the sensation would
“snap” her back into her body and end the seizure. The expe-
rience of being out of her body was unpleasant and alarming,
as she feared something might happen to her body when she
was not in control of it. She believed her perceptions from
an out-of-body visual perspective were accurate and that her
mind physically separated from her body, but she did not
attribute any spiritual significance to that event, regarding it
rather as “just something that happens” when her brain mis-
fires. This was the only patient to report definitively that her
out-of-body experiences commonly included verifiable per-
ceptions, and the only patient to report that she had left her
body frequently during seizures.
(2) A 43-year-old unemployed man with cryptogenic
localization-related epilepsy of unknown etiology had
2–3 complex partial seizures a year, starting at age 6. He
was also diagnosed with bipolar affective disorder without
psychosis, alcohol dependence, and cocaine abuse; and
he had a chronic daily throbbing headache, occasionally
with blurred vision, photophobia, and gastric distress.
He reported that his seizures were often precipitated by
stress, and he described their phenomenology as becoming
unclear in his thoughts, followed by shaking and loss of
consciousness, without tongue biting or loss of bowel or
bladder control, followed by up to 2 hours of confusion. His
EEG and MRI were normal.
He reported having had two out-of-body experiences
associated with seizures. The first occurred about 15 years
ago: he felt that he definitely left his body and was flying, and
that he encountered many people whom he had known in
his childhood in another city. He had a profoundly beauti-
ful experience in which a person he had known previously
came to him “in an angel form” to show him a woman he
would later marry, but whom he had not yet met at that
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |3
Greyson et al. Out-of-body experiences associated with seizures
time. Around 4–5 years ago he had a second out-of-body
experience during a seizure: he again felt he left his body
and was flying, but this time encountered no one. He had
beautiful feelings of peace, love, and “oneness,” feeling that
everything was interconnected; and he felt that his marriage,
which was failing at that time, held a profound meaning of
which he was previously unaware. This was the only patient
to report a pleasurable out-of-body sensation or to attribute
any spiritual significance to it.
(3) A 26-year-old male college student with symptomatic
localization-related epilepsy had a maximum of 20
intractable complex partial seizures a month with sec-
ondary generalization since age 15, for which he had
undergone left frontal lobectomy at age 20. His seizures were
described as 1 min of unresponsiveness with eyes deviating
to the left, followed by progression to shaking of his right
face and right upper extremity. Intensive telemetry video
EEG showed independent left and right temporal slowing
and frequent left central spikes; during 42 brief seizures
consisting of the head moving forward and looking to the
left with behavioral ar rest, lasting for approximately 15–20 s,
he had bihemispheric slowing, more prominent over the left,
followed by diffuse attenuation of faster frequencies, and
postictal slowing also more prominent over the left. MRI
showed left frontal encephalomalacia and gliosis related to
his surgery, and additional foci of encephalomalacia and
gliosis within the right anterior frontal lobe and lateral aspect
of the temporal lobes. PET/CT also showed postsurgical
changes with encephalomalacia in the left frontal lobe with
corresponding diminished FDG uptake. Single photon
emission computed tomography (SPECT) showed increased
radiotracer activity in the left temporal lobe. He was also
diagnosed with depression, anxiety, and sleep apnea.
He reported a recurrent but vague sense of leaving his
body during seizures (“I feel like I’m seeing myself from
somewhere else on occasion”) but could not elaborate on that
description nor could he say how many times it had occurred.
(4) A 30-year-old unemployed woman with symptomatic
localization-related epilepsy due to subependymal cortical
heterotopias had a maximum of 300 complex partial seizures
a month since age 15, with rare secondary generalizations.
Her seizures were characterized by behavioral arrest with
right facial clonic jerking, aphasia, confusion, and postictal
sleepiness. Prolonged video EEG monitoring showed interic-
tal bilateral multifocal epileptiform discharges, most promi-
nent in the left frontocentral region. Observed seizures were
associated with frontally dominant generalized spike and
wave discharges. An ictal SPECT showed increased uptake
in the left temporal region. A brain MRI showed multiple
bilateral subependymal heterotopias in the superior lateral
aspect of the lateral ventricles. She also had been treated for
depression and anxiety, with compulsive skin-picking.
She reported 2–3 out-of-body experiences associated with
seizures, which lasted between 10 and 20 s: she stated that she
felt herself lift up and looked down at her inert body and
could see and hear others; she stated that she felt weightless
during this experience and found that frightening. She added:
Itseemsreal,butIknowitcouldntbe;itstoofar-fetched.
I didn’t see anything surprising. It may be my imagination
telling me what I would look like.
(5) A 42-year-old unemployed man with symptomatic
localization-related epilepsy secondary to traumatic
brain injury at age 25 that required multiple craniotomies
ultimately leading to a metal plate being surgically installed
had a maximum of 5 complex partial seizures a week and
frequent secondary generalized seizures. Prolonged video
EEG monitoring showed interictal intermittent left temporal
theta slowing, and independent, bilateral, frontotemporal
spike discharges, more frequent on the left compared to the
right. During the observed complex partial seizures, there
were no definitive clinical lateralizing features, but electro-
graphically there was evidence for left hemispheric onset. An
interictal SPECT scan showed a small right temporal lobe
in keeping with encephalomalacia. An MRI showed right
frontal and temporal encephalomalacia with minimal left
frontal encephalomalacia, as well as changes of left parietal
cranioplasty exerting a mild mass effect on the underlying
brain parenchyma. He described an aura of feeling light-
headed, followed by staring and drooling and a change in
demeanor, with occasional hand automatisms, sometimes
subsequently generalizing to a tonic clonic seizure.
He reported one out-of-body experience associated with
a seizure: he stated that he was awake during the seizure and
watched himself going through it, falling down to one knee.
He reported that he was aware of his brother entering the
room and tried to tell his brother to stop him. He claimed
to have dual consciousness in that he felt the bodily sensa-
tions of going through the seizure but also saw himself going
through it. He added: “I don’t remember any of the details
of it. It’s like a dream in my memory now.” When asked
whether he believed he had left his body, he answered: “Well,
obviously I don’t think that sort of thing can really happen.
(6) A 30-year-old unemployed woman with idiopathic gener-
alized epilepsy of unknown etiology had 1–2 catamenial
absence seizures a month since age 15, characterized by eye
fluttering and staring, and unresponsiveness that lasted up
to 30 min. She also had myoclonic head jerking precipitated
by stress and 1–2 tonic-clonic seizures a year. Intensive video
EEG monitoring showed generalized fast spike and wave
discharges consistent with the interictal findings seen in idio-
pathic generalized epilepsy, but no seizures were observed.
A head CT and MRI were normal. She was also diagnosed
with bipolar disorder, attention deficit hyperactivity disorder,
and schizotypal personality disorder.
She reported one out-of-body experience associated with
a seizure 15 years ago: she felt herself rise 5–10 feet above her
body and saw her body “folded up on itself.” She saw her sister
run up to her, and then “everything went blank.” This patient
also reported another out-of-body experience that was not
associated with a seizure but rather during an “astral projec-
tion workshop,” which she felt was quite different from her
seizure-related experience.
(7) A 46-year-old female caretaker at a group home for disabled
children, with cryptogenic localization-related epilepsy, had
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |4
Greyson et al. Out-of-body experiences associated with seizures
a maximum of one simple partial seizure a month since age
9, and tonic-clonic seizures without tongue biting or uri-
nary incontinence less than once a year. Her typical seizures
werecharacterizedbyanauraofdéjàvufollowedbystaring,
unresponsiveness, and rocking activity, followed by postictal
confusion lasting up to an hour with body aches, headache,
and fatigue. She also had depression, sleep apnea, hypothy-
roidism, and type 1 diabetes mellitus, and reported that her
seizures seemed to be precipitated by hypoglycemia or emo-
tional stress. She had had two head injuries, at ages 23 and
45, from falls secondary to hypoglycemia. Her EEG showed
lefttemporalsharpwaves,butherMRIandheadCTwere
normal.
She reported one episode of feeling as if she were looking
into her head, as if she were an observer of her own thoughts.
She felt at that time as if she were “floating in the universe,
seeing blackness, but with planets and stars. She reported that
experience as very frightening because she had no control
over the floating.
DEMOGRAPHIC AND SUBJECTIVE EXPERIENTIAL CORRELATES OF
OUT-OF-BODY EXPERIENCE
As shown in Ta b l e 2 , the 7 patients who reported out-of-body
experiences and the remaining 93 patients who did not were
statistically comparable in terms of age, gender, education, and
ethnicity.
The frequency of recalled subjective experiences associated
with seizures was statistically comparable between those patients
who reported out-of-body experiences and those who did not
(χ2=2.78, df =3; NS). Among the 7 patients who reported
out-of-body experiences associated with their seizures, 2 (29%)
attributed their recalled subjective experiences to the aura prior to
the seizure, 5 (71%) to the seizure itself, and 1 (14%) to the pos-
tictal period. The percent of patients who reported out-of-body
Table 2 | Demographics among patients with and without
out-of-body experiences (OBEs).
OBE (N=7) No OBE (N=93) Statistical test
Mean age 34.1 (SD =8.5) 40.2 (SD =13.0) t=1.20,
df =98; NS
Gender χ2=0.11,
df =1; NS
Female 4 (47%) 47 (51%)
Male 3 (43%) 46 (49%)
Ye a r s o f
education
13.7 (SD =1.9) 13.0 (SD =2.7) t=0.64,
df =98; NS
Ethnicity χ2=0.15,
df =2; NS
Euro-American 6 (86%) 78 (84%)
African-American 1 (14%) 13 (14%)
Latino-American 0 (0%) 2 (2%)
experiences and of those who did not were statistically compa-
rable for those experiences attributed to the pre-ictal aura (χ2=
1.88, df =1; NS), for the seizure itself (χ2=1.13, df =1; NS),
and for the postictal period (χ2=2.21, df =1; NS).
As shown in Ta b l e 3 , with the Bonferroni correction for mul-
tiple simultaneous statistical tests, those patients who reported
out-of-body experiences scored higher than did other patients on
the NDE Scale and on the individual items assessing out-of-body
experience and a sense of being in an unearthly realm.
SEIZURE HISTORY
The mean age at onset of seizures for the 97 patients for whom
such data were available was 18.7 years (SD =13.1), with a range
from 0 to 65. The mean duration of the seizure disorder for those
97 patients was 20.9 years (SD =13.5), with a range from 1 to 57
years. The mean maximum seizure frequency of the 91 patients
for whom data were available was 42.0 per month (SD =72.8),
with a range from <1 to 300.
As shown in Ta b l e 4 , patients who reported out-of-body expe-
riences and those who did not were statistically comparable in
terms of age of onset, duration of seizure disorder, and maximum
seizure frequency.
SEIZURE CHARACTERISTICS
Epilepsy etiology was unknown for 58 patients. Among the
remaining 42 patients, 29 (69%) had seizures related to focal
pathology, including focal congenital malformation, mesial tem-
poral sclerosis, chronic localized encephalitis, and benign tumor;
and 13 (31%) to generalized or multifocal pathology, includ-
ing diffuse head injury, generalized congenital malformation,
perinatal anoxia, and multiple intracerebral hemorrhages.
Seizure type was classifiable for 97 patients, of whom 71
(73%) had complex partial seizures; 10 (10%) had simple par-
tial seizures, including focal motor, somatosensory, autonomic,
déjà vu, and cognitive seizures; and 16 (16%) had generalized
seizures, including tonic-clonic, absence, and myoclonic seizures
or multiple generalized.
Epilepsy syndrome was classifiable for 56 patients, of whom 44
(81%) had a localization-related syndrome, including mesial tem-
poral lobe (7 patients), frontal lobe (5), parietal lobe (2), as well as
non-classified cryptogenic (30); and 12 (22%) had a generalized
epilepsy syndrome, including juvenile myoclonic (3 patients),
and other idiopathic (7), as well as non-specific symptomatic
generalized (1) and cryptogenic generalized epilepsy (1).
Epilepsy etiology, seizure type, and epilepsy syndrome are pre-
sented in Ta b l e 5 , listed separately for those patients who did and
did not report out-of-body experiences. None of these seizure
characteristics differentiated the two groups.
EEG DATA
Sixty-five patients had EEG findings that included localizable
epileptiform discharges, among whom 35 (57%) were localized in
the temporal lobe, 6 (10%) elsewhere, and 20 (33%) were multi-
focal. Sixty-one patients had lateralizable epileptiform discharges,
of whom 26 (40%) could be localized in the left hemisphere,
11 (17%) in the right hemisphere, 18 (28%) were bilateral, and
10 (15%) generalized. As indicated in Ta b l e 6 , neither discharge
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |5
Greyson et al. Out-of-body experiences associated with seizures
Table 3 | NDE Scale scores of patients with and without out-of-body experiences (OBEs).
OBE (N=7) No OBE (N=93) Statistical test
NDE Scale (range =0–32) 4.71 (SD =1.70) 1.49 (SD =1.50) t=5.43, df =98; p<0.001
ITEM (RANGE = 0–2)
Time distortion 0.71 (SD =0.95) 0.39 (SD =0.59) t=1.35, df =98; NS
Thought acceleration 0.29 (SD =0.49) 0.13 (SD =0.34) t=1.15, df =98; NS
Life review 0.43 (SD =0.79) 0.11 (SD =0.35) t=2.12, df =98; NS
Sudden understanding 0.00 (SD =0.00) 0.03 (SD =0.18 ) t=−0.48, df =98; NS
Sense of peace 0.00 (SD =0.00) 0.11 (SD =0.35) t=−0.82, df =98; NS
Feeling of joy 0.00 (SD =0.00) 0.03 (SD =0.18 ) t=−0.48, df =98; NS
Sense of cosmic unity 0.00 (SD =0.00) 0.02 (SD =0.15) t=−0.39, df =98; NS
Bright light 0.29 (SD =0.49) 0.11 (SD =0.35) t=1.28, df =98; NS
Sensory vividness 0.14 (SD =0.38) 0.19 (SD =0.40) t=−0.33, df =98; NS
Extrasensory perception 0.00 (SD =0.00) 0.03 (SD =0.18) t=−0.48, df =98; NS
Precognitive vision 0.00 (SD =0.00) 0.08 (SD =0.34) t=−0.59, df =98; NS
Out-of-body experience 2.00 (SD =0.00) 0.17 (SD =0.38) t=12.69, df =98; p <0.001
Unearthly realm 0.57 (SD =0.98) 0.04 (SD =0.25) t=3.93, df =98; p <0.001
Mystical presence 0.29 (SD =0.76 ) 0. 03 (SD =0.23) t=2.22, df =98; NS
Visible spirits 0.00 (SD =0.00) 0.01 (SD =0.10 ) t=−0.27, df =98; NS
Border 0.00 (SD =0.00) 0.02 (SD =0.21) t=−
0.27, df =98; NS
Table 4 | Seizure history among patients with and without
out-of-body experiences (OBEs).
OBE (N=7) No OBE (N=93) Statistical
test
Age of onset 15.7 18.9 t=0.58,
(SD =7.7) (SD =13.3) df =94; NS
Years of seizure 19.3 21.0 t=0.29,
disorder (SD =14.0) (SD =13.5) df =94; NS
Maximum 51.3 41.2 t=0.35,
seizures/month (SD =110 .2) (SD =69.8) df =89; NS
localization nor lateralization significantly differentiated those
patients who did and did not report out-of-body experiences.
QUALITY OF LIFE
The mean score on the QOLIE-10 for the 99 patients who were
able to complete it was 25.0 (SD =8.1), with a range from 12
to 44, which was not statistically different from the mean score
of 25.6 (SD =8.9) among a normative sample of patients with
epilepsy (t=0.70, df =98; NS) (Bautista et al., 2007). The mean
scores on the component factors were 7.1 (SD =3.2) for Epilepsy
Effect, 7.7 (SD = 2.4) for Mental Health, and 10.3 (SD =4.5)
for Role Function. These were statistically comparable to norma-
tive scores for patients with epilepsy for Epilepsy Effect (t=1.54,
df =98; NS) and for Role Function (t=0.78, df =98; NS), but
lower (reflecting better quality of life) than the mean score of 8.4
for Mental Health (t=3.02, df =98, p=0.003) (Bautista et al.,
2007).
As shown in Ta b l e 7 , patients who reported out-of-body expe-
riences and those who did not were statistically comparable in
Table 5 | Seizure characteristics among patients with and without
out-of-body experiences (OBEs).
OBE (N=7) No OBE (N=93) Statistical test
Epilepsy etiology χ2=0.01,df =2; NS
Focal pathology 2 (29%) 27 (29%)
Generalized
pathology
1 (14% ) 12 (13% )
Unknown 4 (57%) 54 (58%)
Seizure type χ2= 0.38, df =3; NS
Complex partial 5 (71%) 66 (71%)
Simple partial 1 (14%) 9 (10%)
Generalized 1 (14%) 15 (16%)
Unclassified 0 (0%) 3 (3%)
Epilepsy
syndrome
χ2=0.87,df =2; NS
Localization-
related
6 (86%) 67 (72%)
Generalized 1 (14%) 18 (19%)
Unknown 0 (0%) 8 (9%)
terms of overall quality of life, as well as for quality of life related
to Epilepsy Effect, Mental Health, and Role Function.
DISCUSSION
OUT-OF-BODY EXPERIENCES ASSOCIATED WITH SEIZURES
Among our sample of 100 patients, 7 reported out-of-body expe-
riences associated with their seizures, although some of their
descriptions were not definitive. This percent was comparable
to the 6.3% prevalence reported by Devinsky et al. (1989),and
slightly lower than the 9% prevalence of out-of-body experiences
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |6
Greyson et al. Out-of-body experiences associated with seizures
Table 6 | EEG variables among patients with and without out-of-body
experiences (OBEs).
OBE (N=6) No OBE (N=80) Statistical test
Epileptiform discharge
localization
χ2=1.35,
df =3; NS
Temporal lobe 2 (33%) 33 (41%)
Other locus 0 (0%) 6 (8%)
Multifocal 3 (50%) 17 (21%)
None 1 (17%) 24 (30%)
Epileptiform discharge
lateralization
χ2=5.43,
df =4; NS
Left-sided 4 (67%) 22 (28%)
Right-sided 0 (0%) 11 (14%)
Bilateral 1 (17%) 17 (21%)
Generalized 1 (17%) 9 (11%)
None 0 (0%) 21 (26%)
Table 7 | Quality of life among patients with and without out-of-body
experiences (OBEs).
OBE (N=7) No OBE (N=92) Statistical test
QOLIE total score 24.2 (SD =9.0) 25.1 (SD =8.1) t=0.30, df =97; NS
QOLIE FACTORS
Epilepsy effect 7.7 (SD =3.4) 7.1 (SD =3.2) t=0.52, df =97; NS
Mental health 7.9 (SD =2.9) 7.7 (SD =2.3) t=0.20, df =97; NS
Role function 10.0 (SD =4.4) 10.3 (SD =4.5) t=0.30, df =97; NS
typically reported in surveys of the general population (Cardeña
and Alvarado, 2013).Threeofthepatientsinoursamplereported
only one out-of-body experience, 1 reported 2 such experiences,
1 reported “2 or 3” experiences, 1 reported a vague sense of
leaving his body but could not estimate how many times that
had happened, and 1 reported that she left her body with every
seizure.
The finding that 6 of the 7 patients who reported out-of-body
experiences associated with seizures described them as occur-
ring only once or twice many years ago raises the question of
whether those experiences were truly seizure-related. In view
of the fact that 9% of the general population (presumably free
of seizures) report out-of-body experiences once or twice in a
lifetime (Cardeña and Alvarado, 2013) and the documented unre-
liability of patients’ memories of their seizures (Heo et al., 2006;
Quigg, 2011), partly as a result of anterograde amnesia from hip-
pocampal involvement, it is conceivable that at least some of the
out-of-body experiences reported in this study may not have been
related to seizures but were erroneously attributed to seizures in
retrospect.
Patients who reported out-of-body experiences were statis-
tically indistinguishable from others in terms of age, gender,
education, and ethnicity. They reported being able to recall sub-
jective experiences associated with their seizures as often as did
the comparison patients, and their recollections were assigned to
the aura preceding the seizure, the seizure itself, and the postictal
period, at the same rate as for comparison patients. Impairment
of consciousness associated with seizures is central to the effect of
epilepsy on quality of life, primarily due to their unpredictabil-
ity (Mann and Cavanna, 2011). However, those patients who
reported out-of-body experiences and those who did not were
statistically comparable in terms of quality of life.
We anticipated that patients who reported out-of-body expe-
riences would also score higher on the NDE Scale than did
comparison patients, as a sense of leaving the body is one item
on that scale. However, in addition to that item, patients who
reported out-of-body experiences also reported with greater fre-
quency a sense of being in some other realm or dimension. It
is unclear whether that sense of being in another realm referred
to the out-of-body experience itself or to a different experience,
as only 1 of the 7 patients (patient # 2) included in his out-
of-body experience a sense of leaving the immediate physical
surroundings of the body.
COMPARISON TO SPONTANEOUS OUT-OF-BODY EXPERIENCES AND
INDUCED BODY IMAGE DISTORTIONS
Although out-of-body experiences commonly reported to occur
spontaneously or in NDEs are typically pleasurable and often
interpreted as spiritual experiences (Gabbard and Twemlow,
1984; Cardeña and Alvarado, 2013), only one of the patients in
this sample reported his seizure-related out-of-body sensations
to be pleasurable or attributed any religious or spiritual signif-
icance to the sensation of being out of the body (patient # 2).
The remaining 6 felt their out-of-body experiences to be unpleas-
ant or frightening, echoing the findings of Devinsky et al. (1989)
that two of their patients found autoscopy to be the most trou-
bling aspects of their disorder. Indeed, autoscopy associated with
seizures is commonly accompanied by intense horror or fear,
and may be associated with suicide (Brugger et al., 1994). Again,
this negative affect contrasts with the blissful nature of the out-
of-body phenomenon typically reported as part of spontaneous
NDEs (Gabbard and Twemlow, 1984), and with the suicide-
inhibiting effect of NDEs (Greyson, 1992).
As noted above, purported out-of-body experiences have pre-
viously been associated with electrical stimulation of the right
angular gyrus near the temporo-parietal lobe (Blanke et al., 2002),
and Hoepner et al. (2013) reported that out-of-body experi-
ences were associated with seizure foci at the temporo-parietal
junction “or neighboring region.” Recently, this link between the
temporo-parietal junction and out-of-body sensations has been
explored in persons without any known neurological dysfunc-
tion. Braithwaite et al. (2011) found that college students who
reported spontaneous out-of-body experiences scored higher
on a questionnaire designed to assess temporal lobe instability
and disruptions in processing of body image than did students
without out-of-body experiences. While that study was intrigu-
ing, the authors cautioned that questionnaires do not provide
direct evidence of underlying neural function, and that if atten-
uated temporo-parietal discharges did occur in persons without
epilepsy, the underlying neurophysiology would be unknown.
Despite these suggestive data, however, the out-of-body expe-
riences reported by the 7 patients in this study were not associated
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |7
Greyson et al. Out-of-body experiences associated with seizures
primarily with right temporo-parietal foci. One patient had pre-
dominant left temporal discharges, 1 had left central, 1 had
bilateral temporal, 1 had bilateral frontal, 1 had bilateral multi-
focal with left frontal predominance, and 2 had no epileptiform
discharges on EEG. This is consistent with the finding of Devinsky
et al. (1989) that autoscopic phenomena may be associated with
a variety of seizure types, as well as with the general observation
that focal seizures can affect distant and widespread regions of the
brain (Bagshaw and Cavanna, 2011). Most of the research sug-
gesting temporo-parietal correlates of out-of-body experiences
has used imaging techniques that identify relatively focal activ-
ity. The development of methods for characterizing the activity of
functional networks rather than discrete foci may lead to better
understanding of these phenomena, particularly those associ-
ated with seizures, which can modify functional connectivity and
affect resting state networks (Bagshaw and Cavanna, 2013).
Patients in the current study who did and did not report out-
of-body experiences were comparable in their seizure histories,
including epilepsy syndrome, epilepsy etiology, and seizure type.
Complex partial seizures accounted for about 71% of the seizures
in both groups. EEG findings, including lateralization and local-
ization of abnormalities, did not differentiate those who reported
out-of-body experiences from those who did not. The curious
finding that the only case of déjà vu/jamais vu seizure occurred
in a patient who reported an out-of-body experience may bear
further investigation.
Studies of out-of-body phenomena associated with seizures
have been confounded by conflicting definitions of the experience
(Braithwaite et al., 2011). Hoepner et al. (2013) delineated three
types of ictal autoscopic phenomena that differ in their degree
of disembodiment and visual perspective: in true autoscopy, the
self does not feel disembodied but remains in the physical body
and visualizes a “double” in the extracorporeal space; in out-of-
body experiences, the self feels fully disembodied and visualizes
the physical body from an extracorporeal viewpoint; and in heau-
toscopy, the self feels ambiguously disembodied and the visual
perspective changes between the intra- and extracorporeal. It
remains an open question whether these various forms of body
image distortion are related or distinct phenomena (Braithwaite
et al., 2011).
Patients with epilepsy who have perceptual distortions, illu-
sions, or hallucinations associated with their seizures generally
have insight into the unreality of such perceptions, since they
experience them across a spectrum of unusual experiences on
many occasions associated with seizures (Bien et al., 2000; Elliott
et al., 2009). In contrast, patients with thought disorders like
schizophrenia generally do not have insight into the unreality
of their hallucinations. If this distinction holds for out-of-body
experiences, then we would expect that patients would recog-
nize such experiences associated with seizures as hallucinatory
and not real. In fact, only 1 of our 7 patients who reported out-
of-body experiences (patient #1) believed that her out-of-body
experiences were real. The other patients either recognized their
out-of-body sensations as hallucinatory or expressed doubts,
reporting, for example, “It seems real, but I know it couldn’t be,”
“It may be my imagination,” “It’s like a dream,” or, “Obviously, I
don’t think that sort of thing can really happen.
It is unclear whether a definitive belief that one had truly
left the body is a distinct phenomenon or simply the extreme
end of a continuum that includes more nebulous reports of
out-of-body sensations that the experiencers do not believe was
real. Brief survey questions cannot resolve this issue; rather, it
requires detailed discussion with the experiencer, as half the peo-
ple who respond affirmatively on questionnaires assessing belief
in anomalous experiences do not in fact understand what they
are professing but are expressing “quasi-beliefs”—propositions
believed to be true without knowledge of their meaning—rather
than informed beliefs, even when they are basing their knowledge
on personal experiences (Jinks, 2012).
The experimental literature on induced out-of-body experi-
ences has been furthermore confounded by eccentric uses of the
term. Some researchers studying sensations induced by exoge-
nous electrical stimulation included as an “out-of-body expe-
rience” any distortion of body image, regardless of whether it
involved a subjective sense of leaving the physical body. Blanke
et al. (2002) described as an “out-of-body experience” induced
by electrical stimulation sensations of sinking into the bed, see-
ing one’s legs become shorter or moving quickly toward one’s
face, and feeling that one’s upper body was moving toward
the legs. One study that reported “out-of-body experiences”
elicited by stimulating the posterior right superior temporal gyrus
acknowledged that the patient continued to perceive the envi-
ronment from his real-person perspective, and not from the
disembodied perspective as in spontaneous out-of-body expe-
riences (DeRidder et al., 2007). Another reported an illusion
they classified as “belonging to the class of OBEs” elicited by
transcranial magnetic stimulation over the cerebellum in which
the patient felt her body falling sideways out of her chair, but
did not describe any visual impressions (Schutter et al., 2006).
Cardeña and Marcusson-Clavertz (2012) have recently high-
lighted the inappropriate use of terms used to denote anomalous
experiences by scholars unfamiliar with the clear and specific
connotations of those terms as they are used in psychology and
related disciplines. They concluded that anomalous experiences
must be studied within the context of a thorough understand-
ingofthephenomenaandthecorrectuseofterms(Cardeña and
Marcusson-Clavertz, 2012).
It is unclear how comparable seizure-related autoscopy and
heautoscopy or electrically induced body image distortions are
to spontaneous out-of-body experiences. As noted above, the
unpleasant affect associated with seizure-related out-of-body sen-
sations is unlike the blissful sensations usually accompanying
spontaneous out-of-body and NDEs. Furthermore, the sense of
disembodiment induced by electrical stimulation is limited to a
fixed location; experiencers perceive the environment from the
visual perspective of the physical body; and experiencers per-
ceive the event as illusory. In contrast, spontaneous out-of-body
experiences often involve accurate perception of the environment
(including the physical body) from an extracorporeal visual per-
spective; the disembodied center of consciousness may seem to
move about independently of the physical body; and experiencers
usually perceive the event as profoundly real (Greyson et al.,
2008). Patients who report body image distortions during brain
stimulation do so when their eyes are open, but not when their
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |8
Greyson et al. Out-of-body experiences associated with seizures
eyes are closed, unlike spontaneous out-of-body experiences,
which typically occur with the eyes closed (Giesler-Petersen,
2008). Body image distortions elicited by brain stimulation are
transitory, disappearing when the patient attempts to inspect the
illusory body part, whereas spontaneous out-of-body experiences
are not transitory but are maintained during examination of the
body image (Neppe, 2002). Finally, somatic illusions induced
by brain stimulation typically involve viewing only part of the
body, usually include distortions like shortening or lengthening of
limbs and movement, and are experienced as confusing; whereas
spontaneous out-of-body experiences involve seeing the entire
body from an extracorporeal perspective, do not include distor-
tions, and are experienced as exceptionally lucid (Holden et al.,
2006).
Whereas there is no way to establish that autoscopy and heau-
toscopy are anything more than illusions, it is possible to test
whether subjective out-of-body experiences are more than illu-
sions by seeking verification of the veridicality of perceptions
from the extracorporeal perspective. Although people who report
out-of-body experiences that occur spontaneously or in NDEs
often claim to have accurate perceptions from a disembodied
visual perspective (Greyson et al., 2008), only one patient in our
sample (not the patient who described the sensations as pleasur-
able) believed unambiguously that her out-of-body perceptions
were accurate perceptions of reality that could be corroborated
by others. Four others described viewing events from an out-of-
body perspective that they thought might or might not have been
accurate, and 2 of the 7 expressed outright disbelief in the reality
of their out-of-body sensations.
The term “altered state of consciousness,” which is com-
monly used to encompass a wide range of pathological and
non-pathological conditions, including epileptic seizures and
spontaneous out-of-body experiences, carries for many the impli-
cation of abnormality or dysfunction. The alternative term “non-
ordinary mental expression” (NOME) has been suggested to
designate anomalous experiences and related neuropsychological
processes without implying pathology. Although reductionistic
pathophysiological models may not encompass the entire range of
such phenomena, brain areas and neurotransmitters involved in
these experiences may provide a common terrain for both patho-
logical and non-pathological NOMEs, creating a substrate for the
association of phenomena such as out-of-body experiences with
neuropathologic events such as epileptic seizures.
METHODOLOGICAL ISSUES
The data from this study must be interpreted with some caution.
First, the small number of patients who reported out-of-body
experiences reduced the likelihood of finding significant statistical
differences from the patients who did not. It is possible that with
a much larger sample, some of the non-significant trends noted
in this study might prove to differentiate patients who report out-
of-body experiences and those who do not, such as the somewhat
higher incidence of left-sided and multifocal discharges among
those who reported out-of-body experiences.
Another factor to be considered in evaluating the implications
of this study was the role of comorbid psychiatric disorder in
the association of out-of-body experiences with seizures. Sensky
(1983a) noted that interest in anomalous subjective states in
epilepsy was advanced by Slater and Beard (1963) and Dewhurst
and Beard (1970), who specifically studied patients with comor-
bid psychosis and epilepsy. Of the 7 patients in our study who
reported out-of-body experiences, 3 had been diagnosed with
depression, 2 others with bipolar disorder, 2 with anxiety, 2 with
sleep apnea, and 1 each with attention deficit hyperactivity dis-
order, schizotypal personality disorder, compulsive skin-picking,
alcohol abuse, and cocaine abuse. Only 2 of these 7 patients who
reported out-of-body experiences were not in concurrent psychi-
atric treatment. It is unclear whether psychiatric comorbidity may
have influenced reports of out-of-body experiences in this study;
that question may be a fruitful direction for future research.
As noted above, we chose to identify out-of-body experi-
ences by administering the NDE Scale because that instrument
explicit addresses the phenomenon. There are, however, other
scales that may yield additional helpful information about alter-
ations of consciousness associated with seizures. One of the most
detailed measures for quantifying various aspects of conscious-
ness, the Phenomenology of Consciousness Inventory (Pekala,
1991), has been used to examine dimensions of conscious-
ness and its distortions during seizures (Johanson et al., 2008).
However, that instrument is quite long and some of its items
are complicated and difficult to understand, and some items
have different meaning for patients with epilepsy than for other
persons (Johanson et al., 2008, 2011); it is intended for use
within 20 min of an experience (Pekala, 1991); and it does
not specifically explore out-of-body experiences. The shorter
and less demanding Ictal Consciousness Inventory (Cavanna
et al., 2008) was specifically designed to measure level and
content of consciousness during seizures, but it also does not
address out-of-body experiences. It may be instructive, how-
ever, to include the Ictal Consciousness Inventory in future
research on such phenomena associated with seizures. Reports
of anomalous phenomena like out-of-body experiences dur-
ing seizures may also be explored through unstructured inter-
views, such as EpiC, the Epilepsy-specific Content analysis
method, although that technique is much more time-consuming
and may be less practical in a clinic setting (Johanson et al.,
2011).
Finally, in studying the association of out-of-body experiences
with seizures, and particularly with complex partial seizures, it
should be borne in mind that patients with complex partial
seizures tend to have more frequent attacks, take more drugs,
and suffer more adverse psychosocial stresses than patients with
generalized seizures, all of which may interact to play a role in
psychological symptoms (Reynolds, 1983). Additionally, it may be
misleading to regard all patients with complex partial seizures as
a homogenous group, as laterality and age of onset of the disorder
may importantly influence psychological manifestations (Sensky,
1983b).
CONCLUSION
This study elicited reports of out-of-body sensations associated
with seizures in 7% of patients with epilepsy, but found no
differentiating traits that were associated with patients’ reports
of out-of-body experiences with their seizures, either in terms
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |9
Greyson et al. Out-of-body experiences associated with seizures
of demographics, medical history including seizure risk factors
and precipitants, seizure characteristics including localization and
type of seizure, ability to recall subjective experiences associated
with their seizures, or quality of life.
Considerable progress has been made in recent decades elu-
cidating the neurobiologic correlates of altered states of con-
sciousness, or NOMEs (Bagshaw and Cavanna, 2011, 2013), and
specifically the role of epilepsy in elucidating the neural corre-
lates of consciousness (Mann and Cavanna, 2011). In particular,
there has been a wealth of suggestive evidence bearing on the neu-
rological foundations of body image distortions (Blanke et al.,
2002; Schutter et al., 2006; DeRidder et al., 2007). However, it
may be premature to conclude from these suggestive correlations
that out-of-body experiences are an epiphenomenon of particular
neurophysiological conditions (Neppe, 2002; Holden et al., 2006).
As noted above, the body image distortions elicited by electrical
or magnetic stimulation of the brain differ phenomenologically
from spontaneous out-of-body experiences in several important
ways. The data from this study suggest that out-of-body experi-
ences associated with seizures are not linked to any one region
of the brain. Moreover, the findings that out-of-body experi-
ences were reported slightly less often by patients with epilepsy
than in surveys in the general population, and that patients with
epilepsy who do describe out-of-body experiences report them
occurring in only a small minority of their seizures, raise cau-
tions about inferring a causal link between the seizure activity and
out-of-body experiences.
AUTHOR CONTRIBUTIONS
Bruce Greyson contributed substantially to the conception and
design of this research; to the acquisition, analysis, and interpre-
tation of data for the work; to drafting the work and revising it
critically for intellectual content; gave final approval of the ver-
sion to be published; and agrees to be accountable for all aspects
oftheworkinensuringthatquestionsrelatedtotheaccuracyor
integrity of any part of the work are appropriately investigated
and resolved. Nathan B. Fountain contributed substantially to the
conception and design of this research; to the interpretation of
data for the work; to revising the work critically for intellectual
content; gave final approval of the version to be published; and
agrees to be accountable for all aspects of the work in ensuring
that questions related to the accuracy or integrity of any part
of the work are appropriately investigated and resolved. Lori L.
Derr contributed substantially to the conception and design of
this research; to the acquisition of data for the work; to revis-
ing the work critically for intellectual content; gave final approval
of the version to be published; and agrees to be accountable for
all aspects of the work in ensuring that questions related to the
accuracy or integrity of any part of the work are appropriately
investigated and resolved. Donna K. Broshek contributed sub-
stantially to the conception and design of this research; to the
interpretation of data for the work; to revising the work criti-
cally for intellectual content; gave final approval of the version
to be published; and agrees to be accountable for all aspects of
theworkinensuringthatquestionsrelatedtotheaccuracyor
integrity of any part of the work are appropriately investigated
and resolved.
REFERENCES
Bagshaw, A. P., and Cavanna, A. E. (2011). Brain mechanisms of altered conscious-
ness in focal seizures. Behav. Neurol. 24, 35–41. doi: 10.3233/BEN-2011-0312
Bagshaw, A. P., and Cavanna, A. E. (2013). Resting state networks in
paroxysmal disorders of consciousness. Epilepsy Behav. 26, 290–294. doi:
10.1016/j.yebeh.2012.09.020
Bautista, R. E. D., Glen, E. T., and Shetty, N. K. (2007). Factors associated with
satisfaction with care among patients with epilepsy. Epilepsy Behav. 11, 518–524.
doi: 10.1016/j.yebeh.2007.07.019
Bien, C., Benninger, F. O., Urbach, H., Schramm, J., Kurthen, M., and Elger, C.
E. (2000). Localizing value of epileptic visual auras. Brain 123, 244–253. doi:
10.1093/brain/123.2.244
Blanke, O., Ortigue, S., Landis, T., and Seeck, M. (2002). Stimulating illusory own-
body perceptions. Nature 419, 269–270. doi: 10.1038/419269a
Braithwaite, J. J., Samson, D., Apperly, I., Broglia, E., and Hulleman, J. (2011).
Cognitive correlates of the spontaneous out-of-body experience (OBE) in the
psychologically normal population: evidence for an increased role of temporal-
lobe instability, body-image-distortion processing, and impairments in own-
body transformations. Cortex 47, 839–953. doi: 10.1016/j.cortex.2010.05.002
Brugger, P., Agosti, R., Regard, M., Wieser, H.-G., and Landis, T. (1994).
Heautoscopy, epilepsy, and suicide. J. Neurol. Neurosurg. Psychiatry. 57,
838–839. doi: 10.1136/jnnp.57.7.838
Cardeña, E., and Alvarado, C. S. (2013). “Anomalous self and identity experiences,”
in Varieties of Anomalous Experience: Examining the Scientific Evidence,2nd
Edn., eds E. Cardeña, S. J. Lynn, and S. Krippner (Washington, DC: American
Psychological Association), 175–212. doi: 10.1037/14258-007
Cardeña, E., and Marcusson-Clavertz, D. (2012). On the need to com-
pare anomalous experiences carefully. Conscious. Cogn. 21, 1068–1069. doi:
10.1016/j.concog.2012.02.003
Cavanna, A. E., Mula, M., Servo, S., Strigaro, G., Tota, G., Barbagli, D., et al.
(2008). Measuring the level and content of consciousness during epileptic
seizures: the Ictal Consciousness Inventory. Epilepsy Behav. 13, 184–188. doi:
10.1016/j.jebeh.2008.01.009
Commission on Classification and Terminology of the International League
Against Epilepsy. (1989). Proposal for revised classification of epilep-
sies and epileptic syndromes. Epilepsia 30, 389–399. doi: 10.1111/j.1528-
1157.1989.tb05316.x
Cramer, J. A., Perrine, K., Devinsky, O., and Meadow, K. (1996). A brief ques-
tionnaire to screen for quality of life in epilepsy: the QOLIE-10. Epilepsia 37,
577–582. doi: 10.1111/j.1528-1157.1996.tb00612.x
DeRidder, D., Van Laere, K., Dupont, P., Menovsky, T., and Van de Heyning, P.
(2007). Visualizing out-of-body experiences in the brain. N.Engl.J.Med.357,
1829–1833. doi: 10.1056/NEJMoa070010
Devinsky, O., Feldmann, E., Burrowes, K., and Broomfield E. (1989). Autoscopic
phenomena with seizures. Arch. Neurol. 46, 1080–1088. doi: 10.1001/arch-
neur.1989.00520460060015
Dewhurst, K., and Beard, A. W. (1970). Sudden religious conversions in temporal
lobe epilepsy. Brit. J. Psychiat. 117, 497–507. doi: 10.1192/bjp.117.540.497
Dreifuss, F. E., Bancaud, J., Henriksen, O., Rubio-Donnadieu, F., Seino, M., and
Penry, J. K. (1981). Proposal for the revised clinical and electroencephalographic
classification of epileptic seizures. Epilepsia 22, 489–501. doi: 10.1111/j.1528-
1157.1981.tb06159.x
Elliott, B., Joyce, E., and Shorvon, S. (2009). Delusions, illusions and hallucina-
tions in epilepsy: 1. Elementary phenomena. Epilepsy Res. 85, 162–171. doi:
10.1016/j.eplepsyres.2009.03.018
Gabbard, G. O., and Twemlow, S. W. (1984). With the Eyes of the Mind: an Empirical
Analysis of Out-of-Body States.NewYork,NY:Praeger.
Giesler-Petersen, I. (2008). Further commentary on “induced OBEs.J. Near-Death
Stud. 26, 306–308.
Greyson, B. (1983).The near-death experience scale: construction, reliability, and
validity. J. Nerv. Ment. Dis. 171, 369–375. doi: 10.1097/00005053-198306000-
00007
Greyson, B. (1992). Near death experiences and anti-suicidal attitudes. Omega 26,
81–89.
Greyson, B., Parnia, S., and Fenwick, P. (2008). Visualizing out-of-body experience
in the brain. N. Engl. J. Med. 358, 855–856. doi: 10.1056/NEJMc073315
Heo, K., Han, S., Lim, S. R., Kim, M. A., and Lee, B. I. (2006). Patient aware-
ness of complex partial seizures. Epilepsia 47, 1931–1935. doi: 10.1111/j.1528-
1167.2006.00820.x
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |10
Greyson et al. Out-of-body experiences associated with seizures
Hoepner, R., Labudda, K., May, T. W., Schoendienst, M., Woermann, F. G., Bien,
C. G., et al. (2013). Ictal autoscopic phenomena and near death experiences:
a study of five patients with ictal autoscopies. J. Neurol. 260, 742–749. doi:
10.1007/s00415-012-6689-x
Holden, J. M., Long, J., and MacLurg, J. (2006). Out-of-body experiences: all in the
brain? J. Near-Death Stud. 25, 99–107.
Jinks, A. L. (2012). Paranormal and alternative health beliefs in quasi-beliefs:
implications for item content in paranormal belief questionnaires. Aust. J .
Para psych ol. 12, 127–158.
Johanson, M., Revonsuo, A., Chaplin, J., and Wedlund, J.-E. (2003). Level and con-
tents of consciousness in connection with partial complex seizures. Epilepsy
Behav. 4, 279–285. doi: 10.1016/S1525-5050(03)00106-9
Johanson, M., Valli, K., and Revonsuo, A. (2011). How to assess ictal consciousness?
Behav. Neurol. 24, 11–20. doi: 10.3233/BEN-2011-0316
Johanson, M., Valli, K., Revonsuo, A., Chaplin, J. E., and Wedlund, J.-E. (2008).
Alterations in the contents of consciousness in partial epileptic patients. Epilepsy
Behav. 13, 366–371. doi: 10.1016/j.yebeh.2008.04.014
Lange, R., Greyson, B., and Houran, J. (2004). A Rasch scaling valida-
tion of a ‘core’ near-death experience. Br.J.Psychol.95, 161–177. doi:
10.1348/000712604773952403
Mann, J. P., and Cavanna, A. E. (2011). What does epilepsy tell us about the neural
correlates of consciousness? J. Neuropsychiatry Clin. Neurosci. 23, 375–383. doi:
10.1176/appi.neuropsych.23.4.375
Neppe, V. M. (2002). “Out-of-body experiences” (OBEs) and brain localization. A
perspective. Aust. J. Parapsychol. 2, 85–96.
Pekala, R. J. (1991). Quantifying Consciousness: an Empirical Approach.NewYork,
NY: Plenum.
Quigg, M. (2011). “Monitoring seizure frequency and severity in outpatients,” in
Evidence-Based Management of Epilepsy,edS.C.Schachter(Shrewsbury:tfm
Publishing), 21–31.
Reynolds, E. H. (1983). Interictal behaviour in temporal lobe epilepsy. Br. Med. J.
286, 918–919. doi: 10.1136/bmj.286.6369.918
Schutter, D. J., Kammers, M. P., Enter, D., and van Honk, J. (2006). A
case of illusory own-body perceptions after transcranial magnetic stimu-
lation of the cerebellum. Cerebellum 5, 238–240. doi: 10.1080/1473422060
0791469
Sensky, T. (1983a). “Religiosity, mystical experience and epilepsy,” in Research
Progress in Epilepsy, ed F. C. Rose (Bath: Pitman), 214–220.
Sensky, T. (1983b). Interictal behavior in temporal lobe epilepsy [Letter]. Br. Med.
J. 286, 1982.
Slater, E., and Beard, A. W. (1963). The schizophrenia-like psychoses of epilepsy:
I. Psychiatric aspects. Br. J. Psychiat. 109, 95–112. doi: 10.1192/bjp.109.
458.95
Conflict of Interest Statement: The authors declare that the research was con-
ducted in the absence of any commercial or financial relationships that could be
construed as a potential conflict of interest.
Received: 20 December 2013; accepted: 27 January 2014; published online: 13 February
2014.
Citation: Greyson B, Fountain NB, Derr LL and Broshek DK (2014) Out-of-body
experiences associated with seizures. Front. Hum. Neurosci. 8:65. doi: 10.3389/fnhum.
2014.00065
This article was submitted to the journal Frontiers in Human Neuroscience.
Copyright © 2014 Greyson, Fountain, Derr and Broshek. This is an open-access arti-
cle distributed under the terms of the Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other forums is permitted, provided the
original author(s) or licensor are credited and that the original publication in this
journal is cited, in accordance with accepted academic practice. No use, distribution or
reproduction is permitted which does not comply with these terms.
Frontiers in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 65 |11
... Epilepsy caused by PVNH with clinical features of out-of-body experiences, have been reported before (Greyson, Fountain, Derr, & Broshek, 2014), but the network involved has not been described. Autoscopic phenomena represent complex episodes of visual illusory self-duplication defined as the perception of one's own body in the extrapersonal space. ...
Article
Periventricular nodular heterotopias (PVNH) are areas of neurons abnormally located in the white matter that might be involved in physiological cortical functions. Autoscopic hallucinations are changes in self-consciousness determined by a mismatch in integration of multiple sensory inputs. Our goal is to highlight the brain network involved in generation of autoscopic hallucination elicited by electrical stimulation of a PVNH in a drug resistant epilepsy patient. Our patient was explored using stereo-electroencephalography with electrodes covering the right posterior temporal PVNH and the adjacent cortex. Direct electrical high frequency stimulation of the PVNH elicited autoscopic hallucinations mainly involving the face and upper trunk. We then used multiple modalities to determine brain connectivity: single pulse electrical stimulation of the PVNH and stimulation-evoked potentials were used to highlight resting state effective connectivity. High-frequency stimulation using alternating polarity pulses enabled us to identify the network involved, time-locked to the clinical effect and to map symptom-related effective connectivity. Functional connectivity using a non-linear regression method was used to determine dependencies between different cortical regions following the stimulation. Finally, structural connectivity was highlighted using deterministic fiber tracking. Multi-modal connectivity analysis identified a network involving the PVNH, occipital and temporal neocortex, fusiform gyrus and parietal cortex.
... From an etiological and topographical perspective, out-ofbody experiences have been reported in a wide variety of neurological conditions, including epilepsy, migraine, awake craniotomy, drug use, post-eclamptic brain damage, neoplasia, infarction, cerebral infection, and psychiatric disease (schizophrenia, depression, anxiety, and dissociative disorders) (Devinsky, Feldmann, Burrowes, & Bromfield, 1989;Dening & Berrios, 1994;Brugger et al., 1997;Blanke et al., 2004;Blanke & Arzy, 2005;Zamboni, Budriesi, & Nichelli, 2005;T, 2008;Wilkins, Girard, & Cheyne, 2012;Greyson, Fountain, Derr, & Broshek, 2014;Bos, Spoor, Smits, Schouten, & Vincent, 2016). Blanke et al. (Blanke et al., 2004) reported a series of patients with autoscopic phenomena and found evidence for moderate neuropsychological deficits (aphasia, agraphia, alexia and apraxia) compatible with posterior cortical involvement, as confirmed by lesion analysis. ...
... The interpretation of NDEs and OBEs as equivalent to temporal lobe epilepsy (Britton & Bootzin, 2004) is unfounded: recent studies show that there is no correlation between OBEs included in NDEs and epileptiform abnormalities (Greyson, Fountain, Derr, & Broshek, 2014). ...
... abnormal integration of visual, somatosensory and vestibular signals explains the disembodiment (Lopez & Elzi ere, 2018). Although OBEs may exhibit various aetiologies (e.g., psychiatric diseases, migraine or sleep paralysis), few neurological patients with OBEs caused by brain damage have been reported (Blanke et al., 2004;Blanke, Ortigue, Landis, & Seeck, 2002;Bos, Spoor, Smits, Schouten, & Vincent, 2016;Brandt, Kramme, Storm, & Pohlmann-Eden, 2009;Brugger, Regard, & Landis, 1997;Daly, 1958;De Ridder, Van Laere, Dupont, Menovsky, & Van de Heyning, 2007;Devinsky et al., 1989;Greyson, Fountain, Derr, & Broshek, 2014;Lunn, 1970;Maillard, Vignal, Anxionnat, Taillandier, & Vespignani, 2004;Yu et al., 2018). In terms of the neural basis of OBEs, almost all cases exhibit involvement of the temporoparietal junction (TPJ), as revealed by electrical stimulation and lesional studies (Blanke et al., 2004;Bos et al., 2016;Maillard et al., 2004). ...
Article
Full-text available
An out‐of‐body experience (OBE) is a phenomenon whereby an individual views his/her body and the world from a location outside the physical body. Previous studies have suggested that the temporoparietal junction (TPJ), the brain region responsible for integrating multisensory signals, is responsible for OBE development. Here, however, we first present a case of OBE after brain tumour development in the posterior cingulate cortex (PCC). The patient was a 46‐year‐old right‐handed female; she underwent brain surgery. She reported that she had experienced OBEs several times monthly (during daily life) before surgery but never after surgery. She defined her OBEs explicitly; she drew pictures. Her OBEs exhibited phenomenological, overt dissociation of the subjective and objective bodies. We discuss the mechanisms underlying this phenomenon and the relationship between OBEs and the PCC in terms of anatomical and functional brain connectivity. Our case sheds some light on the mechanism involved in creating spatial (dis)unity between the self and the body.
Article
Full-text available
The paper provides a brief review of the literature, including a case study, of anomalous human experiences (AHEs) such as glossolalia, xenolalia, out-of-body experiences (OBEs) and near-death experiences (NDEs). AHEs are frequently experienced by a number of the healthy as well as the pathological population. The first part of the paper looks at the literature describing phenomenology as well as semiology of the AHEs and their common features. The second part looks at the literature reflecting possible transformative and transcendent elements of the AHEs. The last part of the paper examines the literature presenting the possible pathological as well as spiritual nature of AHEs.
Preprint
Full-text available
The aim of this essay is to describe several ostensibly odd experiences considered implausible, illusory or hallucinatory phenomena, largely considered to be disorders of the neurological or psychological functioning from the ruling mechanist-reductionist perspective of neurosciences. A rigorous but open-minded neurophenomenological approach is required to properly investigate and understand such Non-Ordinary Mental Expressions (NOMEs). Individuals who experience NOMEs should not feel like they are outsiders or abnormal and should feel free to talk about their uncommon experiences, and professionals should listen to them with an open-minded, non-prejudicial and non-judgmental approach. NOMEs challenges the ruling stance of medical and psychological science and suggest intriguing properties of human consciousness, which are likely to be incompatible with the accepted axioms and theories, showing the inescapable epistemological implications of their proper investigation and understanding.
Article
Full-text available
Aim: Auditory Verbal Hallucinations (AVH) are experienced as the “voices” of others (O-AVH) or self (S-AVH) in internal space/inside the head (IS-AVH) or external space (ES-AVH), and are considered to result from agency and spatial externalizations of inner speech. Both types of externalizations are conflated, and the relationship between these externalizations and AVH experiences is unclear. In this paper, I investigate the relationship between cognitive agency and spatial externalizations and between these externalizations and the types of AVH experience. Method: Twenty-five patients with history of AVH and 24 matched healthy controls performed agency and spatial distinction tasks: distinction between self-generated (read) (S) sentences and other-generated (O) sentences, and between sentences read silently (experienced in internal space, IS) and sentences read aloud (experienced in external space, ES). Regression analyses between misattribution biases (S-O vs. IS-ES, and O-S vs. ES-IS) were obtained. t tests were used to compare misattribution biases between AVH subtypes (S-AVH vs. O-AVH, and IS-AVH vs. ES-AVH). Results: Regressions suggest that agency distinction is independent from spatial distinction in both groups. O-AVH and S-AVH subgroups differed only with respect to S-O bias, and IS-AVH and ES-AVH subgroups differed only with respect to IS-ES bias. Conclusion: These results suggest that agency and spatial externalizations of inner speech are independent at phenomenological and cognitive and levels; and that these externalizations are co-related across levels. I discuss the implications of these findings in the wider context of research on AVH on the experience of the self.
Chapter
Full-text available
Review of research on spirit possession, OBEs, and related experiences
Article
Full-text available
Near-death experiences (NDEs) have been described consistently since antiquity and more rigorously in recent years. Investigation into their mechanisms and effects has been impeded by the lack of quantitative measures of the NDE and its components. From an initial pool of 80 manifestations characteristic of NDEs, a 33-item scaled-response preliminary questionnaire was developed, which was completed by knowledgeable subjects describing their 74 NDEs. Items with significant item-total score correlations that could be grouped into clinically meaningful clusters constituted the final 16-item NDE Scale. The scale was found to have high internal consistency, split-half reliability, and test-retest reliability; was highly correlated with Ring's Weighted Core Experience Index; and differentiated those who unequivocally claimed to have had NDEs from those with qualified or questionable claims. This reliable, valid, and easily administered scale is clinically useful in differentiating NDEs from organic brain syndromes and nonspecific stress responses, and can standardize further research into mechanisms and effects of NDEs.
Article
A revision of the International Classification of Epileptic Seizures is proposed based upon a study of videotapes of simultaneously recorded electrical and clinical manifestations of epileptic seizures.
Article
Varieties of Anomalous Experience: Examining the Scientific Evidence. Etzel Cardeña. Steven Jay Lynn. and Stanley Krippner (Eds.). Washington, D.C.: American Psychological Association, 2000. 476 pp., $39.95 (cloth).
Article
Near-death experiences (NDEs) have been reported to decrease fear of death and foster a “romanticized” view of death, yet also promote antisuicidal attitudes. This study was an empirical investigation of psychodynamic hypotheses suggested to explain that paradoxical effect, using a thirty-six-item questionnaire constructed for this purpose. One hundred-fifty near-death experiencers (NDErs) and forty-three individuals who had come close to death but not had NDEs (nonNDErs) rated as true or false twelve antisuicidal attitudes that have been hypothesized to result from NDEs. NDErs endorsed significantly more of the antisuicidal statements than nonNDErs, and among NDErs, number of statements endorsed was positively associated with depth of experience. Those antisuicidal attitudes that showed the greatest difference in endorsement rate between NDErs and nonNDErs related to transpersonal or transcendental beliefs. These data support prior naturalistic observations that NDEs foster antisuicidal attitudes by promoting a sense of purpose in life.
Article
In 1953, in an article intended for the general practitioner, Denis Hill made a brief reference to the chronic paranoid psychoses which may develop in association with temporal lobe epilepsy. He described the condition as likely to come on when the seizures were diminishing in frequency, as appearing gradually with onset in middle age, and as resembling a paranoid schizophrenic state. In 1957, D. A. Pond, from the same department of applied electro-physiology at the Maudsley Hospital, gave a more detailed account of the clinical features. He described the psychotic states as closely resembling schizophrenia, with paranoid ideas which might become systematized, ideas of influence, auditory hallucinations often of a menacing quality; and occasional frank thought disorder with neologisms, condensed words and inconsequential sentences. There were, however, also some points of difference, of a quantitative rather than qualitative kind: a religious colouring of the paranoid ideas was common; the affect tended to remain warm and appropriate; and there was no typical deterioration to the hebephrenic state. All the patients had epilepsy arising from the temporal lobe region with complex auras; occasional major seizures occurred in sleep only. EEG foci, always present, were sometimes only to be demonstrated in sleep-sphenoidal records. The epilepsy began some years before the psychotic symptoms, usually in the late teens or the twenties; and the latter often seemed to begin as the epileptic attacks were diminishing in frequency, either spontaneously or with drug treatment.