Right-side spatial neglect and white matter disconnection after left-hemisphere strokes

The role of white matter variability in TMS neuromodulatory effects

BACKGROUND

Transcranial Magnetic Stimulation (TMS) is a widely used tool to explore the causal role of focal brain regions in cognitive processing. TMS effects over attentional processes are consistent and replicable, while at the same time subjected to individual variability. This individual variability needs to be understood to better comprehend TMS effects, and most importantly, its clinical applications.

OBJECTIVE

This study aimed to explore the role of white matter variability in TMS neuromodulatory effects on behavior in healthy participants (N = 50).

METHODS

Participants completed an attentional task in which orienting and alerting cues preceded near-threshold targets. Continuous Theta Burst Stimulation (cTBS) was applied over the left frontal eye field (FEF) or an active vertex condition. White matter was explored with diffusion-weighted imaging tractography and Tract-Based Spatial Statistics (TBSS).

RESULTS

Behaviorally, TMS over the left FEF slowed down reaction times (especially in the alerting task), impaired accuracy in the objective task, and reduced the proportion of seen targets (as compared to the vertex condition). Attentional effects increased, overall, when TMS was applied to the left FEF as compared to the vertex condition. Correlations between white matter and TMS effects showed i) reduced TMS effects associated with the microstructural properties of long-range white matter pathways such as the superior longitudinal fasciculus (SLF), and interhemispheric fibers of the corpus callosum (CC), and ii) increased TMS effects in participants with high integrity of the CC connecting the stimulated region with the opposite hemisphere. Additionally, variability in attentional effects was also related to white matter, showing iii) increased alerting effects in participants with low integrity of association, commissural, and projection fibers, and iv) increased orienting effects in participants with high integrity of the right SLF III.

CONCLUSION

All these observations highlight the importance of taking into account individual variability in white matter for the understanding of cognitive processing and brain neuromodulation effects.

Same, Same but Different? A Multi-Method Review of the Processes Underlying Executive Control

Attention, working memory, and executive control are commonly considered distinct cognitive functions with important reciprocal interactions. Yet, longstanding evidence from lesion studies has demonstrated both overlap and dissociation in their behavioural expression and anatomical underpinnings, suggesting that a lower dimensional framework could be employed to further identify processes supporting goal-directed behaviour. Here, we describe the anatomical and functional correspondence between attention, working memory, and executive control by providing an overview of cognitive models, as well as recent data from lesion studies, invasive and non-invasive multimodal neuroimaging and brain stimulation. We emphasize the benefits of considering converging evidence from multiple methodologies centred on the identification of brain mechanisms supporting goal-driven behaviour. We propose that expanding on this approach should enable the construction of a comprehensive anatomo-functional framework with testable new hypotheses, and aid clinical neuroscience to intervene on impairments of executive functions.

Disengagement of attention with spatial neglect: A systematic review of behavioral and anatomical findings

The present review examined the consequences of focal brain injury on spatial attention studied with cueing paradigms, with a particular focus on the disengagement deficit, which refers to the abnormal slowing of reactions following an ipsilesional cue. Our review supports the established notion that the disengagement deficit is a functional marker of spatial neglect and is particularly pronounced when elicited by peripheral cues. Recent research has revealed that this deficit critically depends on cues that have task-relevant characteristics or are associated with negative reinforcement. Attentional capture by task-relevant cues is contingent on damage to the right temporo-parietal junction (TPJ) and is modulated by functional connections between the TPJ and the right insular cortex. Furthermore, damage to the dorsal premotor or prefrontal cortex (dPMC/dPFC) reduces the effect of task-relevant cues. These findings support an interactive model of the disengagement deficit, involving the right TPJ, the insula, and the dPMC/dPFC. These interconnected regions play a crucial role in regulating and adapting spatial attention to changing intrinsic values of stimuli in the environment.

Prism adaptation therapy in spatial neglect: The importance of connectional anatomy

The meta-analysis conducted by Székely et al. described the lack of beneficial effect of prism adaptation in neglect patients. The authors concluded that the results did "not support the routine use of prism adaptation as a therapy for spatial neglect". However, a possible nuance to this conclusion could be that the response (or lack thereof) of neglect patients to prism adaptation may actually depend on the connectional anatomy of their lesion. We develop this idea in our commentary, in order to offer a more balanced perspective on the implications of the findings obtained by Székely et al.

Lesion Network Mapping for Neurological Deficit in Acute Ischemic Stroke

OBJECTIVE

To create a comprehensive map of strategic lesion network localizations for neurological deficits, and identify prognostic neuroimaging biomarkers to facilitate the early detection of patients with a high risk of poor functional outcomes in acute ischemic stroke (AIS).

METHODS

In a large-scale multicenter study of 7,807 patients with AIS, we performed voxel-based lesion-symptom mapping, functional disconnection mapping (FDC), and structural disconnection mapping (SDC) to identify distinct lesion and network localizations for National Institutes of Health Stroke Scale (NIHSS) score. Impact scores were calculated based on the odds ratios or t-values of voxels from voxel-based lesion-symptom mapping, FDC, and SDC results. Ordinal regression models were used to investigate the predictive value of the impact scores on functional outcome (defined as the modified Rankin score at 3 months).

RESULTS

We constructed lesion, FDC, and SDC maps for each item of the NIHSS score, which provided insights into the neuroanatomical substrate and network localization of neurological function deficits after AIS. The lesion impact score of limb ataxia, the SDC impact score of limb deficit, and FDC impact score of sensation and dysarthria were significantly associated with modified Rankin Scale at 3 months. Adding the SDC impact score, FDC impact score, and lesion impact score to the NIHSS total score improved the performance in predicting functional outcomes, as compared with using the NIHSS score alone.

INTERPRETATION

We constructed comprehensive maps of strategic lesion network localizations for neurological deficits that were predictive of functional outcomes in AIS. These results may provide specifically localized targets for future neuromodulation therapies. ANN NEUROL 2023;94:572-584.