Electrophysiological measures of patients with unilateral spatial neglect after brain disease: A systematic review

INTRODUCTION

The investigation of brainwave changes during the recovery process of unilateral spatial neglect (USN) has garnered considerable attention in recent years. This paper presents an updated overview of the evolving brainwave patterns during USN rehabilitation, aiming to predict clinical outcomes and guide the selection of effective recovery strategies.

METHODS

A systematic review was conducted, encompassing English literature published up to June 2024. Databases including PubMed, Web of Science, and clinical trials were utilized. The included studies assessed brainwaves using electroencephalography (EEG) in at least one group with USN. However, the diverse nature of these studies posed challenges for a quantitative synthesis.

RESULTS

The final quantitative synthesis comprised 36 studies, incorporating a total of 4517 data points. The analysis revealed abnormalities in alpha, beta, and gamma brainwave activity, along with alterations in the functional monitoring of the alpha band during USN rehabilitation. Additionally, reductions were observed in specific brainwave components such as P1, N1, P2, P300, early directing attention negativity (EDAN), late directing attention positivity (LDAP), and contingent negative variation (CNV). However, findings regarding measures of synchrony, connectivity, and evoked responses across different frequency bands exhibited variability.

CONCLUSIONS

Various indicators of brainwave activity displayed changes at different stages of post-stroke neglect rehabilitation, highlighting the significance of neural network dysfunction in this process. Nonetheless, due to the diversity of the studies, further investigation is necessary to achieve a more comprehensive understanding in future research endeavors.

Modulation of the neuronal response in human primary visual cortex by re-entrant projections during retinal input processing as manifest in the visual evoked potential

Initial deflections in the visual evoked potential (VEP) reflect the neuronal process of extracting features from the retinal input; a process not modulated by re-entrant projections. Later deflections in the VEP reflect the neuronal process of combining features into an object, a process referred to as 'object closure' and modulated by re-entrant projections. Our earlier work indicated that the VEP reflects independent neuronal responses processing temporal - and spatial luminance contrast and that these responses arise from an interaction between forward and re-entrant input. In this earlier work, changing the temporal luminance contrast property of a stimulus altered its spatial luminance contrast property. We recorded the VEP in 12 volunteers viewing image pairs of a windmill, regular dartboard or an RMS dartboard rotated by either Π/4, Π/2, 3Π/4 or Π radians with respect to each other. The windmill and regular dartboard had identical white to black ratio, while the two dartboards identical contrast edges per unit area. Rotation varied temporal luminance contrast of a stimulus without affecting its spatial luminance contrast. N75, P100, N135 and P240 amplitude and latency were compared and a source localisation and temporal frequency analysis performed. P100 amplitude signals a neuronal response processing temporal luminance contrast that is modulated by re-entrant projections with fast axonal conduction velocities. N135 and P240 signal the neuronal response processing spatial luminance contrast and is modulated by re-entrant projections with slow axonal conduction velocities. The dorsal stream is interconnected by fast axonal conduction velocities, the ventral stream by slow axonal conduction velocities.

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.

Temporal features of size constancy for perception and action in a real-world setting: A combined EEG-kinematics study

A stable representation of object size, in spite of continuous variations in retinal input due to changes in viewing distance, is critical for perceiving and acting in a real 3D world. In fact, our perceptual and visuo-motor systems exhibit size and grip constancies in order to compensate for the natural shrinkage of the retinal image with increased distance. The neural basis of this size-distance scaling remains largely unknown, although multiple lines of evidence suggest that size-constancy operations might take place remarkably early, already at the level of the primary visual cortex. In this study, we examined for the first time the temporal dynamics of size constancy during perception and action by using a combined measurement of event-related potentials (ERPs) and kinematics. Participants were asked to maintain their gaze steadily on a fixation point and perform either a manual estimation or a grasping task towards disks of different sizes placed at different distances. Importantly, the physical size of the target was scaled with distance to yield a constant retinal angle. Meanwhile, we recorded EEG data from 64 scalp electrodes and hand movements with a motion capture system. We focused on the first positive-going visual evoked component peaking at approximately 90 ms after stimulus onset. We found earlier latencies and greater amplitudes in response to bigger than smaller disks of matched retinal size, regardless of the task. In line with the ERP results, manual estimates and peak grip apertures were larger for the bigger targets. We also found task-related differences at later stages of processing from a cluster of central electrodes, whereby the mean amplitude of the P2 component was greater for manual estimation than grasping. Taken together, these findings provide novel evidence that size constancy for real objects at real distances occurs at the earliest cortical stages and that early visual processing does not change as a function of task demands.

Event-related brain potentials reveal enhancing and compensatory mechanisms during dual neurocognitive and cycling tasks

BACKGROUND

Various neurocognitive tests have shown that cycling enhances cognitive performance compared to resting. Event-related potentials (ERPs) elicited by an oddball or flanker task have clarified the impact of dual-task cycling on perception and attention. In this study, we investigate the effect of cycling on cognitive recruitment during tasks that involve not only stimulus identification but also semantic processing and memory retention.

METHODS

We recruited 24 healthy young adults (12 males, 12 females; mean age = 22.71, SD = 1.97 years) to perform three neurocognitive tasks (namely color-word matching, arithmetic calculation, and spatial working memory) at rest and while cycling, employing a within-subject design with rest/cycling counterbalancing.

RESULTS

The reaction time on the spatial working memory task was faster while cycling than at rest at a level approaching statistical significance. The commission error percentage on the color-word matching task was significantly lower at rest than while cycling. Dual-task cycling while responding to neurocognitive tests elicited the following results: (a) a greater ERP P1 amplitude, delayed P3a latency, less negative N4, and less positivity in the late slow wave (LSW) during color-word matching; (b) a greater P1 amplitude during memory encoding and smaller posterior negativity during memory retention on the spatial working memory task; and (c) a smaller P3 amplitude, followed by a more negative N4 and less LSW positivity during arithmetic calculation.

CONCLUSION

The encoding of color-word and spatial information while cycling may have resulted in compensatory visual processing and attention allocation to cope with the additional cycling task load. The dual-task cycling and cognitive performance reduced the demands of semantic processing for color-word matching and the cognitive load associated with temporarily suspending spatial information. While dual-tasking may have required enhanced semantic processing to initiate mental arithmetic, a compensatory decrement was noted during arithmetic calculation. These significant neurocognitive findings demonstrate the effect of cycling on semantic-demand and memory retention-demand tasks.

Hierarchical psychophysiological pathways subtend perceptual asymmetries in Neglect

Stroke patients with left Hemispatial Neglect (LHN) show deficits in perceiving left contralesional stimuli with biased visuospatial perception towards the right hemifield. However, very little is known about the functional organization of the visuospatial perceptual neural network and how this can account for the profound reorganization of space representation in LHN. In the present work, we aimed at (1) identifying EEG measures that discriminate LHN patients against controls and (2) devise a causative neurophysiological model between the discriminative EEG measures. To these aims, EEG was recorded during exposure to lateralized visual stimuli which allowed for pre-and post-stimulus activity investigation across three groups: LHN patients, lesioned controls, and healthy individuals. Moreover, all participants performed a standard behavioral test assessing the perceptual asymmetry index in detecting lateralized stimuli. The between-groups discriminative EEG patterns were entered into a Structural Equation Model for the identification of causative hierarchical associations (i.e., pathways) between EEG measures and the perceptual asymmetry index. The model identified two pathways. A first pathway showed that the combined contribution of pre-stimulus frontoparietal connectivity and individual-alpha-frequency predicts post-stimulus processing, as measured by visual-evoked N100, which, in turn, predicts the perceptual asymmetry index. A second pathway directly links the inter-hemispheric distribution of alpha-amplitude with the perceptual asymmetry index. The two pathways can collectively explain 83.1% of the variance in the perceptual asymmetry index. Using causative modeling, the present study identified how psychophysiological correlates of visuospatial perception are organized and predict the degree of behavioral asymmetry in LHN patients and controls.

Spatiotemporal Dynamics of Covert Attention With Different Degrees of Central Visual Field Defects: An ERP and sLORETA Study

Purpose

The present study aimed to investigate the spatiotemporal dynamics of covert attention by simulating different degrees of central visual field defects in healthy subjects.

Methods

An electroencephalogram (EEG) was recorded while 40 normal-sighted subjects performed a target discrimination task. Target stimuli simulated different defect degrees of the central visual field by artificially central scotomas (5, 10, 20, and 30 degrees of visual angle) masked on the center of black-and-white checkerboards. Event-related potentials (ERPs) and standardized low-resolution brain electromagnetic tomography (sLORETA) based on ERPs were analyzed.

Results

ERP results indicated that during early perceptual processes, compared with 5-degree and 10-degree defects, N1 amplitudes of 20-degree and 30-degree defects decreased, whereas P2 amplitudes significantly reduced in 30-degree defects. During later discrimination and decision processing, N2 amplitudes gradually increased from 5-degree to 30-degree defects, whereas P3 amplitudes gradually decreased. Source localization indicated that 5-degree and 10-degree defects had stronger activations than 20-degree and 30-degree defects from the occipital cortex to the ventral stream and dorsal streams. Especially, 30-degree defects primarily recruited additional activations in the ventrolateral prefrontal cortex and ventral stream and later caused the disconnection of dorsolateral prefrontal-posterior parietal cortices in the dorsal stream.

Conclusions

Different degrees of central visual field defects differed in distinct spatiotemporal characteristics at multiple stages of covert attention, from top-down forward feedback and attentional allocation to executive controls through ventral and dorsal processing streams, suggesting that the combination of ERP and source localization can reveal the spatiotemporal control capacity of the cortex on central visual field defects.

Audiospatial evoked potentials for the assessment of spatial attention deficits in patients with severe cerebrovascular accidents

INTRODUCTION

Neuropsychological assessment of spatial orientation in post-acute patients with large brain lesions is often limited due to additional cognitive disorders like aphasia, apraxia, or reduced responsiveness.

METHODS

To cope with these limitations, we developed a paradigm using passive audiospatial event-related potentials (pAERPs): Participants were requested to merely listen over headphones to horizontally moving tones followed by a short tone ("target"), presented either on the side to which the cue moved or on the opposite side. Two runs of 120 trials were presented and we registered AERPs with two electrodes, mounted at C3 and C4. Nine sub-acute patients with large left hemisphere (LH) or right hemisphere (RH) lesions and nine controls participated.

RESULTS

Patients had no problems completing the assessment. RH patients showed a reduced N100 for left-sided targets in all conditions. LH patients showed a diminished N100 for invalid trials and contralesional targets.

CONCLUSION

Measuring AERPs for moving auditory cues and with two electrodes allows investigating spatial attentional deficits in patients with large RH and LH lesions, who are often unable to perform clinical tests. Our procedure can be implemented easily in an acute and rehabilitation setting and might enable investigating spatial attentional processes even in patients with minimal conscious awareness.

Prediction, Suppression of Visual Response, and Modulation of Visual Perception: Insights From Visual Evoked Potentials and Representational Momentum

When a visual object changes its position along with certain sequential regularities, the visual system rapidly and automatically forms a prediction regarding the future position of the object based on the regularities. Such prediction can drastically alter visual perception. A phenomenon called representational momentum (RM: a predictive displacement of the perceived final position of a visual object along its recent regular pattern) has provided extensive evidence for the predictive modulation of visual perception. The purpose of the present study was to identify neural effects that could explain individual differences in the strength of the predictive modulation of visual perception as measured by RM. For this purpose, in two experiments with a conventional RM paradigm where a bar was discretely presented in a regular rotation manner (with a step of 18° in Experiment 1 and a step of 20° in Experiment 2), visual evoked potentials (VEPs) in response to the regularly rotated bar were measured, and correlations between the magnitudes of RM and VEPs were examined. The results showed that the magnitudes of RM and central P2 were negatively correlated, consistently in both experiments; participants who showed a smaller central P2 tended to exhibit greater RM. Together with a previous proposal that central P2 would represent delayed reactivation of lower visual areas around the striate and prestriate cortices via reentrant feedback projections from higher areas, the present results suggest that greater suppression of delayed reactivation of lower visual areas (as indicated by smaller central P2) may underlie stronger predictive modulation of visual perception (as indicated by greater RM).

Efficacy of Repetitive Transcranial Magnetic Stimulation Combined With Visual Scanning Treatment on Cognitive-Behavioral Symptoms of Unilateral Spatial Neglect in Patients With Traumatic Brain Injury: Study Protocol for a Randomized Controlled Trial

Left hemispatial neglect (LHSN) is a frequent and disabling condition affecting patients who suffered from traumatic brain injury (TBI). LHSN is a neuropsychological syndrome characterized clinically by difficulties in attending, responding, and consciously representing the right side of space. Despite its frequency, scientific evidence on effective treatments for this condition in TBI patients is still low. According to existing literature, we hypothesize that in TBI, LHSN is caused by an imbalance in inter-hemispheric activity due to hyperactivity of the left hemisphere, as observed in LHSN after right strokes. Thus, by inhibiting this left hyperactivity, repetitive Transcranial Magnetic Stimulation (rTMS) would have a rebalancing effect, reducing LHSN symptoms in TBI patients. We plan to test this hypothesis within a single-blind, randomized SHAM controlled trial in which TBI patients will receive inhibitory i-rTMS followed by cognitive treatment for 15 days. Neurophysiological and clinical measures will be collected before, afterward, and in the follow-up. This study will give the first empirical evidence about the efficacy of a novel approach to treating LHSN in TBI patients.

Clinical Trial Registration:https://www.clinicaltrials.gov/ct2/show/NCT04573413?cond=Neglect%2C+Hemispatial&cntry=IT&city=Bologna&draw=2&rank=2, identifier: NCT04573413.

Individual EEG profiling of attention deficits in left spatial neglect: A pilot study

Electrophysiological group studies in brain-damaged patients can be run to capture the EEG correlates of specific cognitive impairments. Nonetheless, this procedure is not adequate to characterize the inter-individual variability present in major neuropsychological syndromes. We tested the possibility of getting a reliable individual EEG characterization of deficits of endogenous orienting of spatial attention in right-brain damaged (RBD) patients with left spatial neglect (N+). We used a single-trial topographical analysis (STTA; [39] of individual scalp EEG topographies recorded during leftward and rightward orienting of attention with central cues in RBD patients with and without (N-) neglect and in healthy controls (HC). We found that the STTA successfully decoded EEG signals related to leftward and rightward orienting in five out of the six N+, five out of the six N- patients and in all the six HC. In agreement with findings from conventional average-group studies, successful classifications of EEG signals in N+ were observed during the 400-800 ms period post-cue-onset, which reflects preserved voluntary engagement of attention resources (ADAN component). These results suggest the possibility of acquiring reliable individual EEG profiles of neglect patients.

Efficacy of repetitive transcranial magnetic stimulation combined with visual scanning treatment on cognitive and behavioral symptoms of left hemispatial neglect in right hemispheric stroke patients: study protocol for a randomized controlled trial

BACKGROUND

Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient.

METHODS

In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell'ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients.

DISCUSSION

Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04080999 . Registered on September 2019.

EEG-based Neglect Detection for Stroke Patients

Spatial neglect (SN) is a neurological syndrome in stroke patients, commonly due to unilateral brain injury. It results in inattention to stimuli in the contralesional visual field. The current gold standard for SN assessment is the behavioral inattention test (BIT). BIT includes a series of penand-paper tests. These tests can be unreliable due to high variablility in subtest performances; they are limited in their ability to measure the extent of neglect, and they do not assess the patients in a realistic and dynamic environment. In this paper, we present an electroencephalography (EEG)-based brain-computer interface (BCI) that utilizes the Starry Night Test to overcome the limitations of the traditional SN assessment tests. Our overall goal with the implementation of this EEG-based Starry Night neglect detection system is to provide a more detailed assessment of SN. Specifically, to detect the presence of SN and its severity. To achieve this goal, as an initial step, we utilize a convolutional neural network (CNN) based model to analyze EEG data and accordingly propose a neglect detection method to distinguish between stroke patients without neglect and stroke patients with neglect.Clinical relevance-The proposed EEG-based BCI can be used to detect neglect in stroke patients with high accuracy, specificity and sensitivity. Further research will additionally allow for an estimation of a patient's field of view (FOV) for more detailed assessment of neglect.

Temporal dynamics of the flash-induced bouncing effect

Two identical visual disks moving toward each other on a two‐dimensional (2D) display are more likely to be perceived as “streaming through” than “bouncing off” each other after their coincidence. However, either a brief auditory tone or visual flash presented at the coincident moment of the disks can strikingly increase the incidence of the bouncing percept. Despite the neural substrates underlying the sound‐induced bouncing effect have been widely investigated, little is known about the neural mechanisms underlying the flash‐induced bouncing effect. The present study used event‐related potential recordings to explore the temporal dynamics of the flash‐induced bouncing effect. The results showed that the amplitude of the postcoincidence parietooccipital P2 component (190–230 ms after coincidence) elicited by the visual motion was significantly smaller on bouncing relative to streaming trials only when the flash was presented but not when absent. In addition, the parietal P3 component (330–430 ms) was found to be larger on bouncing than streaming trials when the flash was presented, but the opposite was true when no flash was presented. These electrophysiological findings suggest that the flash‐induced bouncing effect may occur at both perceptual and postperceptual stages of processing.

Pre-motor deficits in left spatial neglect: An EEG study on Contingent Negative Variation (CNV) and response-related beta oscillatory activity

Right Brain Damaged patients with left spatial neglect (N+), are characterised by poor allocation of attention in the contralesional left side of space. In a recent study (Lasaponara et al., 2018) we showed during orienting of spatial attention with endogenous central cues, both the EEG markers reflecting the early phases of orienting (Early Directing Attention Negativity) and those reflecting the late setting-up of sensory facilitation in the visual cortex (Late Directing Attention Positivity) are disturbed in N+ when these patients attend the left side of space. In the healthy brain, endogenous cues also elicit EEG activity related to the preparation of manual responses to upcoming spatial targets. Here, we wished to expand on our previous findings and investigate the EEG correlates of cue-related response preparation in N+ patients. To this aim we investigated the Contingent Negative Variation (CNV) response and the pre-motor Beta-oscillatory activity evoked by spatially informative central cues during the performance of a Posner task. Due to concomitant contralesional motor impairments, N+ an N- patients performed the task only with the ipsilesional right-hand. Compared to healthy controls and patients without neglect, N+ displayed a pathological suppression of CNV component that was independent of cue direction. In addition, the amplitude of the CNV in response to right-pointing cues was positively correlated with neglect severity in line bisection. N+ also displayed a pathological enhancement of pre-motor Beta oscillations over the left hemisphere during the time period that preceded manual responses to targets in the left side of space, particularly to invalidly cued ones. Synchronization in the Beta-band (ERS) was also correlated with lower detection rate and slower RTs to Invalid targets in the left side of space. These results provide new insights on the premotor components of the spatial orienting deficits suffered by patients with left spatial neglect and can help improving its diagnosis and rehabilitation.

Deconstructing Reorienting of Attention: Cue Predictiveness Modulates the Inhibition of the No-target Side and the Hemispheric Distribution of the P1 Response to Invalid Targets

Orienting of attention produces a “sensory gain” in the processing of visual targets at attended locations and an increase in the amplitude of target-related P1 and N1 ERPs. P1 marks gain reduction at unattended locations; N1 marks gain enhancement at attended ones. Lateral targets that are preceded by valid cues also evoke a larger P1 over the hemisphere contralateral to the no-target side, which reflects inhibition of this side of space [Slagter, H. A., Prinssen, S., Reteig, L. C., & Mazaheri, A. Facilitation and inhibition in attention: Functional dissociation of pre-stimulus alpha activity, P1, and N1 components. Neuroimage, 125, 25–35, 2016]. To clarify the relationships among cue predictiveness, sensory gain, and the inhibitory P1 response, we compared cue- and target-related ERPs among valid, neutral, and invalid trials with predictive (80% valid/20% invalid) or nonpredictive (50% valid/50% invalid) directional cues. Preparatory facilitation over the visual cortex contralateral to the cued side of space (lateral directing attention positivity component) was reduced during nonpredictive cueing. With predictive cues, the target-related inhibitory P1 was larger over the hemisphere contralateral to the no-target side not only in response to valid but also in response to neutral and invalid targets: This result highlights a default inhibitory hemispheric asymmetry that is independent from cued orienting of attention. With nonpredictive cues, valid targets reduced the amplitude of the inhibitory P1 over the hemisphere contralateral to the no-target side whereas invalid targets enhanced the amplitude of the same inhibitory component. Enhanced inhibition was matched with speeded reorienting to invalid targets and drop in attentional costs. These findings show that reorienting of attention is modulated by the combination of cue-related facilitatory and target-related inhibitory activity.

Visual processing features in patients with visual spatial neglect recovering from right-hemispheric stroke

OBJECTIVE

Visual spatial neglect (VSN) is a disorder of spatial-temporal attention, often as a result of traumatic brain injury, including stroke. Accumulating evidence suggests that the recovery from VSN follows a very predictable pattern. In this study, we aimed to determine the specific electrophysiology readout that might have predictive value for recovery from VSN in the typical early events, including the recovery rate of visual processing, within the first four weeks of recovery.

METHODS

This was a prospective study of 18 right ischemic stroke patients with VSN who performed a visual cue-target task within 3 days after stroke. The patients were divided into two groups according to their outcome. We compared behavioral data, the amplitudes and latencies of ERP components（P1, N1, and P300） between patients with persistent-VSN (P-VSN) and those with rapid recovery-VSN (R-VSN).

RESULTS

The amplitudes and latencies of the P1 and N1 components were not significantly influenced by the validity of the cue-based expectancy (all p > 0.05). However, a longer mean P300 latency evoked an effective cue (p < 0.001), and there was a significant difference between the P-VSN and R-VSN groups when using the left target (left hemisphere, p = 0.014; right hemisphere, p = 0.027). The recovery rate found in our study (18.75% at four weeks after stroke) was lower than that of previously reported studies.

CONCLUSIONS

Our findings support the use of the event-related potential as a tool for investigating rapid recovery from VSN after stroke and suggest that other factors, such as an asymmetrical omission toward the contralateral side or impairment in the temporal processing capacity, might also be potential biomarkers of recovery.

Visual-spatial neglect after right-hemisphere stroke: behavioral and electrophysiological evidence

Background:

Visual-spatial neglect (VSN) is a neuropsychological syndrome, and right-hemisphere stroke is the most common cause. The pathogenetic mechanism of VSN remains unclear. This study aimed to investigate the behavioral and event-related potential (ERP) changes in patients with or without VSN after right-hemisphere stroke.

Methods:

Eleven patients with VSN with right-hemisphere stroke (VSN group) and 11 patients with non-VSN with right-hemisphere stroke (non-VSN group) were recruited along with one control group of 11 age- and gender-matched healthy participants. The visual-spatial function was evaluated using behavioral tests, and ERP examinations were performed.

Results:

The response times in the VSN and non-VSN groups were both prolonged compared with those of normal controls (P < 0.001). In response to either valid or invalid cues in the left side, the accuracy in the VSN group was lower than that in the non-VSN group (P < 0.001), and the accuracy in the non-VSN group was lower than that in controls (P < 0.05). The P1 latency in the VSN group was significantly longer than that in the control group (F[2, 30] = 5.494, P = 0.009), and the N1 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.343, P = 0.022). When responding to right targets, the left-hemisphere P300 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.255, P = 0.025). With either left or right stimuli, the bilateral-hemisphere P300 latencies in the VSN and non-VSN groups were both significantly prolonged (all P < 0.05), while the P300 latency did not differ significantly between the VSN and non-VSN groups (all P > 0.05).

Conclusions:

Visual-spatial attention function is impaired after right-hemisphere stroke, and clinicians should be aware of the subclinical VSN. Our findings provide neuroelectrophysiological evidence for the lateralization of VSN.

The Hemispheric Distribution of α-Band EEG Activity During Orienting of Attention in Patients with Reduced Awareness of the Left Side of Space (Spatial Neglect)

EEG studies in healthy humans have highlighted that alpha-band activity is relatively reduced over the occipital-parietal areas of the hemisphere contralateral to the direction of spatial attention. Here, we investigated the hemispheric distribution of alpha during orienting of attention in male and female right brain-damaged patients with left spatial neglect. Temporal spectral evolution showed that in patients with neglect alpha oscillations over the damaged hemisphere were pathologically enhanced both during the baseline-fixation period that preceded cued orienting (capturing tonic alpha changes) and during orienting with leftward, rightward, or neutral-bilateral spatial cues (reflecting phasic alpha changes). Patients without neglect showed a similar though significantly less enhanced hemispheric asymmetry. Healthy control subjects displayed a conventional decrease of alpha activity over the hemisphere contralateral to the direction of orienting. In right-brain-damaged patients, neglect severity in the line bisection task was significantly correlated both with tonic alpha asymmetry during the baseline period and with phasic asymmetries during orienting of attention with neutral-bilateral and leftward cues. Asymmetries with neutral-bilateral and leftward cues were correlated with lesion of white matter tracts linking frontal with parietal-occipital areas. These findings show that disruption of rostrocaudal white matter connectivity in the right hemisphere interferes with the maintenance of optimal baseline tonic levels of alpha and the phasic modulation of alpha activity during shifts of attention. The hemispheric distribution of alpha activity can be used as a diagnostic tool for acquired pathological biases of spatial attention due to unilateral brain damage.SIGNIFICANCE STATEMENT Alpha desynchronization over the hemisphere contralateral to the attended side of space is a reliable marker of attentional orienting in the healthy human brain: can the same marker be used to spot and quantify acquired disturbances of spatial attention after unilateral brain injuries? Are pathological modifications in the hemispheric distribution of alpha specifically linked to attentional neglect for one side of space? We show that in patients with right brain damage the pathological enhancement of alpha oscillations over the parietal and occipital areas of the injured hemisphere is correlated with reduced awareness for the left side of space and with the lesion of white matter pathways that subserve frontal modulation of alpha activity in posterior brain areas.

EEG-based neglect assessment: A feasibility study

BACKGROUND

Spatial neglect (SN) is a neuropsychological syndrome that impairs automatic attention orienting to stimuli in the contralesional visual space of stroke patients. SN is commonly assessed using paper and pencil tests. Recently, computerized tests have been proposed to provide a dynamic assessment of SN. However, both paper- and computer-based methods have limitations.

NEW METHOD

Electroencephalography (EEG) shows promise for overcoming the limitations of current assessment methods. The aim of this work is to introduce an objective passive BCI system that records EEG signals in response to visual stimuli appearing in random locations on a screen with a dynamically changing background. Our preliminary experimental studies focused on validating the system using healthy participants with intact brains rather than employing it initially in more complex environments with patients having cortical lesions. Therefore, we designed a version of the test in which we simulated SN by hiding target stimuli appearing on the left side of the screen so that the subject's attention is shifted to the right side.

RESULTS

Results showed that there are statistically significant differences between EEG responses due to right and left side stimuli reflecting different processing and attention levels towards both sides of the screen. The system achieved average accuracy, sensitivity and specificity of 74.24%, 75.17% and 71.36% respectively.

COMPARISON WITH EXISTING METHODS

The proposed test can examine both presence and severity of SN, unlike traditional paper and pencil tests and computer-based methods.

CONCLUSIONS

The proposed test is a promising objective SN evaluation method.

EEG Correlates of Preparatory Orienting, Contextual Updating, and Inhibition of Sensory Processing in Left Spatial Neglect

Studies with event-related potentials have highlighted deficits in the early phases of orienting to left visual targets in right-brain-damaged patients with left spatial neglect (N+). However, brain responses associated with preparatory orienting of attention, with target novelty and with the detection of a match/mismatch between expected and actual targets (contextual updating), have not been explored in N+. Here in a study in healthy humans and brain-damaged patients of both sexes we demonstrate that frontal activity that reflects supramodal mechanisms of attentional orienting (Anterior Directing Attention Negativity, ADAN) is entirely spared in N+. In contrast, posterior responses that mark the early phases of cued orienting (Early Directing Attention Negativity, EDAN) and the setting up of sensory facilitation over the visual cortex (Late Directing Attention Positivity, LDAP) are suppressed in N+. This uncoupling is associated with damage of parietal-frontal white matter. N+ also exhibit exaggerated novelty reaction to targets in the right side of space and reduced novelty reaction for those in the left side (P3a) together with impaired contextual updating (P3b) in the left space. Finally, we highlight a drop in the amplitude and latency of the P1 that over the left hemisphere signals the early blocking of sensory processing in the right space when targets occur in the left one: this identifies a new electrophysiological marker of the rightward attentional bias in N+. The heterogeneous effects and spatial biases produced by localized brain damage on the different phases of attentional processing indicate relevant functional independence among their underlying neural mechanisms and improve the understanding of the spatial neglect syndrome.SIGNIFICANCE STATEMENT Our investigation answers important questions: are the different components of preparatory orienting (EDAN, ADAN, LDAP) functionally independent in the healthy brain? Is preparatory orienting of attention spared in left spatial neglect? Does the sparing of preparatory orienting have an impact on deficits in reflexive orienting and in the assignment of behavioral relevance to the left space? We show that supramodal preparatory orienting in frontal areas is entirely spared in neglect patients though this does not counterbalance deficits in preparatory parietal-occipital activity, reflexive orienting, and contextual updating. This points at relevant functional dissociations among different components of attention and suggests that improving voluntary attention in N+ might be behaviorally ineffective unless associated with stimulations boosting the response of posterior parietal-occipital areas.

Unilateral spatial neglect after posterior parietal damage

Unilateral spatial neglect is a disabling neurologic deficit, most frequent and severe after right-hemispheric lesions. In most patients neglect involves the left side of space, contralateral to a right-hemispheric lesion. About 50% of stroke patients exhibit neglect in the acute phase. Patients fail to orient, respond to, and report sensory events occurring in the contralateral sides of space and of the body, to explore these portions of space through movements by action effectors (eye, limbs), and to move the contralateral limbs. Neglect is a multicomponent higher-level disorder of spatial awareness, cognition, and attention. Spatial neglect may occur independently of elementary sensory and motor neurologic deficits, but it can mimic and make them more severe. Diagnostic tests include: motor exploratory target cancellation; setting the midpoint of a horizontal line (bisection), that requires the estimation of lateral extent; drawing by copy and from memory; reading, assessing neglect dyslexia; and exploring the side of the body contralateral to the lesion. Activities of daily living scales are also used. Patients are typically not aware of neglect, although they may exhibit varying degrees of awareness toward different components of the deficit. The neural correlates include lesions to the inferior parietal lobule of the posterior parietal cortex, which was long considered the unique neuropathologic correlate of neglect, to the premotor and to the dorsolateral prefrontal cortices, to the posterior superior temporal gyrus, at the temporoparietal junction, to subcortical gray nuclei (thalamus, basal ganglia), and to parietofrontal white-matter fiber tracts, such as the superior longitudinal fascicle. Damage to the inferior parietal lobule of the posterior parietal cortex is specifically associated with the mainly egocentric, perceptual, and exploratory extrapersonal, and with the personal, bodily components of neglect. Productive manifestations, such as perseveration, are not a correlate of posterior parietal cortex damage.

TMS-EEG reveals hemispheric asymmetries in top-down influences of posterior intraparietal cortex on behavior and visual event-related potentials

Clinical data and behavioral studies using transcranial magnetic stimulation (TMS) suggest right-hemisphere dominance for top-down modulation of visual processing in humans. We used concurrent TMS-EEG to directly test for hemispheric differences in causal influences of the right and left intraparietal cortex on visual event-related potentials (ERPs). We stimulated the left and right posterior part of intraparietal sulcus (IPS1) while the participants were viewing and rating the visibility of bilaterally presented Gabor patches. Subjective visibility ratings showed that TMS of right IPS shifted the visibility toward the right hemifield, while TMS of left IPS did not have any behavioral effect. TMS of right IPS, but not left one, reduced the amplitude of posterior N1 potential, 180-220ms after stimulus-onset. The attenuation of N1 occurred bilaterally over the posterior areas of both hemispheres. Consistent with previous TMS-fMRI studies, this finding suggests that the right IPS has top-down control on the neural processing in visual cortex. As N1 most probably reflects reactivation of early visual areas, the current findings support the view that the posterior parietal cortex in the right hemisphere amplifies recurrent interactions in ventral visual areas during the time-window that is critical for conscious perception.

The active construction of the visual world

What we see is fundamentally dependent on where we look. Despite this seemingly obvious statement, many accounts of the neurobiology underpinning visual perception fail to consider the active nature of how we sample our sensory world. This review offers an overview of the neurobiology of visual perception, which begins with the control of saccadic eye movements. Starting from here, we can follow the anatomy backwards, to try to understand the functional architecture of neuronal networks that support the interrogation of a visual scene. Many of the principles encountered in this exercise are equally applicable to other perceptual modalities. For example, the somatosensory system, like the visual system, requires the sampling of data through mobile receptive epithelia. Analysis of a somatosensory scene depends on what is palpated, in much the same way that visual analysis relies on what is foveated. The discussion here is structured around the anatomical systems involved in active vision and visual scene construction, but will use these systems to introduce some general theoretical considerations. We will additionally highlight points of contact between the biology and the pathophysiology that has been proposed to cause a clinical disorder of scene construction - spatial hemineglect.

Effect of Postural Control Demands on Early Visual Evoked Potentials during a Subjective Visual Vertical Perception Task in Adolescents with Idiopathic Scoliosis

Subjective visual vertical (SVV) judgment and standing stability were separately investigated among patients with adolescent idiopathic scoliosis (AIS). Although, one study has investigated the central mechanism of stability control in the AIS population, the relationships between SVV, decreased standing stability, and AIS have never been investigated. Through event-related potentials (ERPs), the present study examined the effect of postural control demands (PDs) on AIS central mechanisms related to SVV judgment and standing stability to elucidate the time-serial stability control process. Thirteen AIS subjects (AIS group) and 13 age-matched adolescents (control group) aged 12–18 years were recruited. Each subject had to complete an SVV task (i.e., the modified rod-and-frame [mRAF] test) as a stimulus, with online electroencephalogram recording being performed in the following three standing postures: feet shoulder-width apart standing, feet together standing, and tandem standing. The behavioral performance in terms of postural stability (center of pressure excursion), SVV (accuracy and reaction time), and mRAF-locked ERPs (mean amplitude and peak latency of the P1, N1, and P2 components) was then compared between the AIS and control groups. In the behavioral domain, the results revealed that only the AIS group demonstrated a significantly accelerated SVV reaction time as the PDs increased. In the cerebral domain, significantly larger P2 mean amplitudes were observed during both feet shoulder-width-apart standing and feet together standing postures compared with during tandem standing. No group differences were noted in the cerebral domain. The results indicated that (1) during the dual-task paradigm, a differential behavioral strategy of accelerated SVV reaction time was observed in the AIS group only when the PDs increased and (2) the decrease in P2 mean amplitudes with the increase in the PD levels might be direct evidence of the competition for central processing attentional resources under the dual-task postural control paradigm.

Visuospatial Asymmetries Arise from Differences in the Onset Time of Perceptual Evidence Accumulation

Healthy subjects tend to exhibit a bias of visual attention whereby left hemifield stimuli are processed more quickly and accurately than stimuli appearing in the right hemifield. It has long been held that this phenomenon arises from the dominant role of the right cerebral hemisphere in regulating attention. However, methods that would enable more precise understanding of the mechanisms underpinning visuospatial bias have remained elusive. We sought to finely trace the temporal evolution of spatial biases by leveraging a novel bilateral dot motion detection paradigm. In combination with electroencephalography, this paradigm enables researchers to isolate discrete neural signals reflecting the key neural processes needed for making these detection decisions. These include signals for spatial attention, early target selection, evidence accumulation, and motor preparation. Using this method, we established that three key neural markers accounted for unique between-subject variation in visuospatial bias: hemispheric asymmetry in posterior α power measured before target onset, which is related to the distribution of preparatory attention across the visual field; asymmetry in the peak latency of the early N2c target-selection signal; and, finally, asymmetry in the onset time of the subsequent neural evidence-accumulation process with earlier onsets for left hemifield targets. Our development of a single paradigm to dissociate distinct processing components that track the temporal evolution of spatial biases not only advances our understanding of the neural mechanisms underpinning normal visuospatial attention bias, but may also in the future aid differential diagnoses in disorders of spatial attention.SIGNIFICANCE STATEMENT The significance of this research is twofold. First, it shows that individual differences in how humans direct their attention between left and right space reflects physiological differences in how early the brain starts to accumulate evidence for the existence of a visual target. Second, the novel methods developed here may have particular relevance to disorders of attention, such as unilateral spatial neglect. In the case of spatial neglect, pathological inattention to left space could have multiple underlying causes, including biased attention, impaired decision formation, or a motor deficit related to one side of space. Our development of a single paradigm to dissociate each of these components may aid in supporting more precise differential diagnosis in such heterogeneous disorders.

Synchronization of fronto-parietal beta and theta networks as a signature of visual awareness in neglect

In the neglect syndrome, the perceptual deficit for contra-lesional hemi-space is increasingly viewed as a dysfunction of fronto-parietal cortical networks, the disruption of which has been described in neuroanatomical and hemodynamic studies. Here we exploit the superior temporal resolution of electroencephalography (EEG) to study dynamic transient connectivity of fronto-parietal circuits at early stages of visual perception in neglect. As reflected by inter-regional phase synchronization in a full-field attention task, two functionally distinct fronto-parietal networks, in beta (15-25Hz) and theta (4-8Hz) frequency bands, were related to stimulus discrimination within the first 200 ms of visual processing. Neglect pathology was specifically associated with significant suppressions of both beta and theta networks engaging right parietal regions. These connectivity abnormalities occurred in a pattern that was distinctly different from what was observed in right-hemisphere lesion patients without neglect. Also, both beta and theta abnormalities contributed additively to visual awareness decrease, quantified in the Behavioural Inattention Test. These results provide evidence for the impairment of fast dynamic fronto-parietal interactions during early stages of visual processing in neglect pathology. Also, they reveal that different modes of fronto-parietal dysfunction contribute independently to deficits in visual awareness at the behavioural level.

To see or not to see; the ability of the magno- and parvocellular response to manifest itself in the VEP determines its appearance to a pattern reversing and pattern onset stimulus

INTRODUCTION

The relationship between stimulus property, brain activity, and the VEP is still a matter of uncertainty.

METHOD

We recorded the VEP of 43 volunteers when viewing a series of dartboard images presented as both a pattern reversing and pattern onset/offset stimulus. Across the dartboard images, the total stimulus area undergoing a luminance contrast change was varied in a graded manner.

RESULTS

We confirmed the presence of two independent neural processing stages. The amplitude of VEP components across our pattern reversing stimuli signaled a phasic neural response based on a temporal luminance contrast selective mechanism. The amplitude of VEP components across the pattern onset stimuli signaled both a phasic and a tonic neural response based on a temporal- and spatial luminance contrast selective mechanism respectively. Oscillation frequencies in the VEP suggested modulation of the phasic neural response by feedback from areas of the dorsal stream, while feedback from areas of the ventral stream modulated the tonic neural response. Each processing stage generated a sink and source phase in the VEP. Source localization indicated that during the sink phase electric current density was highest in V1, while during the source phase electric current density was highest in extra-striate cortex. Our model successfully predicted the appearance of the VEP to our images whether presented as a pattern reversing or a pattern onset/offset stimulus.

CONCLUSIONS

Focussing on the effects of a phasic and tonic response rather than contrast response function on the VEP, enabled us to develop a theory linking stimulus property, neural activity and the VEP.

Two subdivisions of macaque LIP process visual-oculomotor information differently

Although the cerebral cortex is thought to be composed of functionally distinct areas, the actual parcellation of area and assignment of function are still highly controversial. An example is the much-studied lateral intraparietal cortex (LIP). Despite the general agreement that LIP plays an important role in visual-oculomotor transformation, it remains unclear whether the area is primary sensory- or motor-related (the attention-intention debate). Although LIP has been considered as a functionally unitary area, its dorsal (LIPd) and ventral (LIPv) parts differ in local morphology and long-distance connectivity. In particular, LIPv has much stronger connections with two oculomotor centers, the frontal eye field and the deep layers of the superior colliculus, than does LIPd. Such anatomical distinctions imply that compared with LIPd, LIPv might be more involved in oculomotor processing. We tested this hypothesis physiologically with a memory saccade task and a gap saccade task. We found that LIP neurons with persistent memory activities in memory saccade are primarily provoked either by visual stimulation (vision-related) or by both visual and saccadic events (vision-saccade-related) in gap saccade. The distribution changes from predominantly vision-related to predominantly vision-saccade-related as the recording depth increases along the dorsal-ventral dimension. Consistently, the simultaneously recorded local field potential also changes from visual evoked to saccade evoked. Finally, local injection of muscimol (GABA agonist) in LIPv, but not in LIPd, dramatically decreases the proportion of express saccades. With these results, we conclude that LIPd and LIPv are more involved in visual and visual-saccadic processing, respectively.

Prism Adaptation Alters Electrophysiological Markers of Attentional Processes in the Healthy Brain

Neglect patients typically show a rightward attentional orienting bias and a strong disengagement deficit, such that they are especially slow in responding to left-sided targets after right-sided cues (Posner et al., 1984). Prism adaptation (PA) can reduce diverse debilitating neglect symptoms and it has been hypothesized that PA's effects are so generalized that they might be mediated by attentional mechanisms (Pisella et al., 2006; Redding and Wallace, 2006). In neglect patients, performance on spatial attention tasks improves after rightward-deviating PA (Jacquin-Courtois et al., 2013). In contrast, in healthy subjects, although there is evidence that leftward-deviating PA induces neglect-like performance on some visuospatial tasks, behavioral studies of spatial attention tasks have mostly yielded negative results (Morris et al., 2004; Bultitude et al., 2013). We hypothesized that these negative behavioral findings might reflect the limitations of behavioral measures in healthy subjects. Here we exploited the sensitivity of event-related potentials to test the hypothesis that electrophysiological markers of attentional processes in the healthy human brain are affected by PA. Leftward-deviating PA generated asymmetries in attentional orienting (reflected in the cue-locked N1) and in attentional disengagement for invalidly cued left targets (reflected in the target-locked P1). This is the first electrophysiological demonstration that leftward-deviating PA in healthy subjects mimics attentional patterns typically seen in neglect patients. Significance statement: Prism adaptation (PA) is a promising tool for ameliorating many deficits in neglect patients and inducing neglect-like behavior in healthy subjects. The mechanisms underlying PA's effects are poorly understood but one hypothesis suggests that it acts by modulating attention. To date, however, there has been no successful demonstration of attentional modulation in healthy subjects. We provide the first electrophysiological evidence that PA acts on attention in healthy subjects by mimicking the attentional pattern typically reported in neglect patients: both a rightward attentional orienting bias (reflected in the cue-locked N1) and a deficit in attentional disengagement from the right hemispace (reflected in the target-locked P1). This study makes an important contribution to refining current models of the mechanisms underlying PA's cognitive effects.

Neglect-like characteristics of developmental disregard in children with cerebral palsy revealed by event related potentials

BACKGROUND

Children with unilateral Cerebral Palsy (CP) often show diminished awareness of the remaining capacity of their affected upper limb. This phenomenon is known as Developmental Disregard (DD). DD has been explained by operant conditioning. Alternatively, DD can be described as a developmental delay resulting from a lack of use of the affected hand during crucial developmental periods. We hypothesize that this delay is associated with a general delay in executive functions (EF) related to motor behavior, also known as motor EFs.

METHODS

Twenty-four children with unilateral CP participated in this cross-sectional study, twelve of them diagnosed with DD. To test motor EFs, a modified go/nogo task was presented in which cues followed by go- or nogo-stimuli appeared at either the left or right side of a screen. Children had to press a button with the hand corresponding to the side of stimulus presentation. Apart from response accuracy, Event-Related Potentials (ERPs) extracted from the ongoing EEG were used to register covert cognitive processes. ERP N1, P2, N2, and P3 components elicited by cue-, go-, and nogo-stimuli were further analyzed to differentiate between different covert cognitive processes.

RESULTS

Children with DD made more errors. With respect to the ERPs, the P3 component to go-stimuli was enhanced in children with DD. This enhancement was related to age, such that younger children with DD showed stronger enhancements. In addition, in DD the N1 component to cue- and go-stimuli was decreased.

CONCLUSIONS

The behavioral results show that children with DD experience difficulties when performing the task. The finding of an enhanced P3 component to go-stimuli suggests that these difficulties are due to increased mental effort preceding movement. As age in DD mediated this enhancement, it seems that this increased mental effort is related to a developmental delay. The additional finding of a decreased N1 component in DD furthermore suggests a general diminished visuo-spatial attention. This effect reveals that DD might be a neuropsychological phenomenon similar to post-stroke neglect syndrome that does not resolve during development. These findings suggest that therapies aimed at reducing neglect could be a promising addition to existing therapies for DD.

Chinese-English bilinguals processing temporal-spatial metaphor

The conceptual projection of time onto the domain of space constitutes one of the most challenging issues in the cognitive embodied theories. In Chinese, spatial order (e.g.,/da shu qian/, in front of a tree) shares the same terms with temporal sequence (", /san yue qian/, before March). In comparison, English natives use different sets of prepositions to describe spatial and temporal relationship, i.e., "before" to express temporal sequencing and "in front of" to express spatial order. The linguistic variations regarding the specific lexical encodings indicate that some flexibility might be available in how space-time parallelisms are formulated across different languages. In the present study, ERP (Event-related potentials) data were collected when Chinese-English bilinguals processed temporal ordering and spatial sequencing in both their first language (L1) Chinese (Experiment 1) and the second language (L2) English (Experiment 2). It was found that, despite the different lexical encodings, early sensorimotor simulation plays a role in temporal sequencing processing in both L1 Chinese and L2 English. The findings well support the embodied theory that conceptual knowledge is grounded in sensory-motor systems (Gallese and Lakoff, Cogn Neuropsychol 22:455-479, 2005). Additionally, in both languages, neural representations during comprehending temporal sequencing and spatial ordering are different. The time-spatial relationship is asymmetric, in that space schema could be imported into temporal sequence processing but not vice versa. These findings support the weak view of the Metaphoric Mapping Theory.

On the neural origin of pseudoneglect: EEG-correlates of shifts in line bisection performance with manipulation of line length

Healthy participants tend to show systematic biases in spatial attention, usually to the left. However, these biases can shift rightward as a result of a number of experimental manipulations. Using electroencephalography (EEG) and a computerized line bisection task, here we investigated for the first time the neural correlates of changes in spatial attention bias induced by line-length (the so-called line-length effect). In accordance with previous studies, an overall systematic left bias (pseudoneglect) was present during long line but not during short line bisection performance. This effect of line-length on behavioral bias was associated with stronger right parieto-occipital responses to long as compared to short lines in an early time window (100-200ms) post-stimulus onset. This early differential activation to long as compared to short lines was task-independent (present even in a non-spatial control task not requiring line bisection), suggesting that it reflects a reflexive attentional response to long lines. This was corroborated by further analyses source-localizing the line-length effect to the right temporo-parietal junction (TPJ) and revealing a positive correlation between the strength of this effect and the magnitude by which long lines (relative to short lines) drive a behavioral left bias across individuals. Therefore, stimulus-driven left bisection bias was associated with increased right hemispheric engagement of areas of the ventral attention network. This further substantiates that this network plays a key role in the genesis of spatial bias, and suggests that post-stimulus TPJ-activity at early information processing stages (around the latency of the N1 component) contributes to the left bias.

Neural correlates of visual extinction or awareness in a series of patients with right temporoparietal damage

Patients with visual extinction following right-hemisphere damage can typically detect left visual field stimulation when it is presented in isolation, but tend to miss this when it is paired with competing concurrent right visual stimulation. Some single-case studies have provided preliminary evidence that right visual cortex may show residual activation for contralesional, extinguished visual stimuli. Here we go beyond prior work by using individual retinotopic mapping and online eye-tracking during fMRI to study activity in stimulus-responsive retinotopic visual cortex for a case series of four extinction patients. We found consistent activation of retinotopic right visual cortex for bilateral visual stimulation that resulted in left extinction. This residual unconscious activation included areas V1 to V3 and was not due to inadvertent eye movements. We also provide further evidence for the emerging view that awareness may require activity of frontal and parietal regions well beyond visual cortex.

Attention and predictions: control of spatial attention beyond the endogenous-exogenous dichotomy

The mechanisms of attention control have been extensively studied with a variety of methodologies in animals and in humans. Human studies using non-invasive imaging techniques highlighted a remarkable difference between the pattern of responses in dorsal fronto-parietal regions vs. ventral fronto-parietal (vFP) regions, primarily lateralized to the right hemisphere. Initially, this distinction at the neuro-physiological level has been related to the distinction between cognitive processes associated with strategic/endogenous vs. stimulus-driven/exogenous of attention control. Nonetheless, quite soon it has become evident that, in almost any situation, attention control entails a complex combination of factors related to both the current sensory input and endogenous aspects associated with the experimental context. Here, we review several of these aspects first discussing the joint contribution of endogenous and stimulus-driven factors during spatial orienting in complex environments and, then, turning to the role of expectations and predictions in spatial re-orienting. We emphasize that strategic factors play a pivotal role for the activation of the ventral system during stimulus-driven control, and that the dorsal system makes use of stimulus-driven signals for top-down control. We conclude that both the dorsal and the vFP networks integrate endogenous and exogenous signals during spatial attention control and that future investigations should manipulate both these factors concurrently, so as to reveal to full extent of these interactions.

Transcutaneous electrical nerve stimulation effects on neglect: a visual-evoked potential study

We studied the effects of transcutaneous electrical nerve stimulation (TENS) in six right-brain-damaged patients with left unilateral spatial neglect (USN), using both standard clinical tests (reading, line, and letter cancelation, and line bisection), and electrophysiological measures (steady-state visual-evoked potentials, SSVEP). TENS was applied on left neck muscles for 15′, and measures were recorded before, immediately after, and 60′ after stimulation. Behavioral results showed that the stimulation temporarily improved the deficit in all patients. In cancelation tasks, omissions and performance asymmetries between the two hand-sides were reduced, as well as the rightward deviation in line bisection. Before TENS, SSVEP average latency to stimuli displayed in the left visual half-field [LVF (160 ms)] was remarkably longer than to stimuli shown in the right visual half-field [RVF (120 ms)]. Immediately after TENS, latency to LVF stimuli was 130 ms; 1 h after stimulation the effect of TENS faded, with latency returning to baseline. TENS similarly affected also the latency SSVEP of 12 healthy participants, and their line bisection performance, with effects smaller in size. The present study, first, replicates evidence concerning the positive behavioral effects of TENS on the manifestations of left USN in right-brain-damaged patients; second, it shows putatively related electrophysiological effects on the SSVEP latency. These behavioral and novel electrophysiological results are discussed in terms of specific directional effects of left somatosensory stimulation on egocentric coordinates, which in USN patients are displaced toward the side of the cerebral lesion. Showing that visual-evoked potentials latency is modulated by proprioceptive stimulation, we provide electrophysiological evidence to the effect that TENS may improve some manifestations of USN, with implications for its rehabilitation.

Early Visual Processing is Affected by Clinical Subtype in Patients with Unilateral Spatial Neglect: A Magnetoencephalography Study

OBJECTIVE

To determine whether visual evoked magnetic fields (VEFs) elicited by right and left hemifield stimulation differ in patients with unilateral spatial neglect (USN) that results from cerebrovascular accident.

METHODS

Pattern-reversal stimulation of the right and left hemifield was performed in three patients with left USN. Magnetoencephalography (MEG) was recorded using a 160-channel system, and VEFs were quantified in the 400 ms after each stimulus. The presence or absence of VEF components at around 100 ms (P100m component) and 145 ms (N145m component) after stimulus onset was determined. The source of the VEF was determined using a single equivalent current dipole model for spherical volume conduction. All patients were evaluated using the behavioral inattention test (BIT).

RESULTS

In response to right hemifield stimulation, the P100m and N145m components of the VEF were evident in all three patients. In response to left hemifield stimulation, both components were evident in Patient 3, whereas only the P100m component was evident in Patient 1 and only the N145m component was evident in Patient 2. Patient 1 exhibited impairments on the line bisection and cancelation tasks of the BIT, Patient 2 exhibited impairments on the copying, drawing and cancelation tasks of the BIT, and Patient 3 exhibited impairments on the cancelation task of the BIT.

CONCLUSION

These results demonstrate that early VEFs are disrupted in patients with USN and support the concept that deficits in visual processing differ according to the clinical subtype of USN and the lesion location. This study also demonstrates the feasibility of using MEG to explore subtypes of neglect.

Mapping the functional neuroanatomy of spatial neglect and human parietal lobe functions: progress and challenges

Spatial neglect is generally defined by various deficits in processing information from one (e.g., left) side of space contralateral to focal (e.g., right) hemisphere damage. Although classically associated with parietal lobe functions, there is now compelling evidence that neglect can follow lesions in many different cortical and subcortical sites, suggesting a dysfunction in distributed brain networks. In addition, neglect is likely to result from a combination of distinct deficits that co-occur due to concomitant damage affecting juxtaposed brain areas and their connections, but the exact nature of core deficits and their neural substrates still remains unclear. The present review describes recent progress in identifying functional components of the neglect syndrome and relating them to distinct subregions of parietal cortex. A comprehensive understanding of spatial neglect will require a more precise definition of cognitive processes implicated in different behavioral manifestations, as well as meticulous mapping of these processes onto specific brain circuits, while taking into account functional changes in activity that may arise in structurally intact areas subsequent to damage in distant portions of the relevant networks.

The nonspatial side of spatial neglect and related approaches to treatment

In addition to deficits in spatial attention, individuals with persistent spatial neglect almost universally exhibit nonspatially lateralized deficits in sustained and selective attention, and working memory. However, nonspatially lateralized deficits in neglect have received considerably less attention in the literature than deficits in spatial attention. This is in spite of the fact that nonspatially lateralized deficits better predict the chronicity and functional disability associated with neglect than spatially lateralized deficits. Furthermore, only a few treatment studies have specifically targeted nonspatially lateralized deficits as a means to improve spatial neglect. In this chapter, we will briefly review several models of spatial attention bias in neglect before focusing on nonspatial deficits and the mechanisms of nonspatial-spatial interactions and implications for treatment. Treatment approaches that more completely address nonspatial deficits and better account for their interactions with spatial attention will likely produce better outcomes.

Hemispheric differences in VEPs to lateralised stimuli are a marker of recovery from neglect

Visual-evoked potentials (VEPs) were recorded in seventeen patients with unilateral lesions of the right hemisphere (RH) and visuospatial neglect. Hemispheric differences were detected for VEP components in the time window from 130 to 280 msec; this result replicates data from a previous study using a larger group of patients (Di Russo et al., 2008). Three patients were tested twice; their hemispheric differences, i.e., the differences in latency and amplitude of VEPs to ipsilesional and contralesional stimuli, were evaluated at the beginning and end of visuospatial rehabilitation training for neglect. The hemispheric differences were limited to components anterior N1 (N1a), posterior N1 (N1p) and P2 (not C1 and P1) and showed a significant decrease after training; amelioration at the behavioural level was also observed. Fourteen patients were tested only once, at different steps of their training. For the overall group, we determined the correlation between VEP hemispheric differences and the number of sessions attended by the patients at the time of VEP recording. The correlation was negative, the higher the number of sessions, the lower the hemispheric asymmetry, and high, ranging from .45 to .64, for both the latency and amplitude of the N1p and P2 components, and for the amplitude of the N1a component. The correlation between VEP hemispheric differences and time from onset (TFO) of the pathological event was not significant. Overall, the hemispheric differences between specific components of the VEP responses to lateralised stimuli appear to be a good marker of recovery from neglect.