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

Dynamic changes in spatial representation within the posterior parietal cortex in response to visuomotor adaptation

Recent studies used functional magnetic resonance imaging (fMRI) population receptive field (pRF) mapping to demonstrate that retinotopic organization extends from the primary visual cortex to ventral and dorsal visual pathways, by quantifying visual field maps, receptive field size, and laterality throughout multiple areas. Visuospatial representation in the posterior parietal cortex (PPC) is modulated by attentional deployment, raising the question of whether spatial representation in the PPC is dynamic and flexible, and whether this flexibility contributes to visuospatial learning. To answer this question, changes in spatial representation within the PPC and early visual cortex were recorded with pRF mapping before and after prism adaptation (PA)-a well-established visuomotor technique that modulates visuospatial attention according to the direction of the visual displacement. As predicted, results showed that adaptation to left-shifting prisms increases pRF size in left PPC, while leaving space representation in the early visual cortex unchanged. This is the first evidence that PA drives a dynamic reorganization of response profiles in the PPC. These findings show that spatial representations in the PPC not only reflect changes driven by attentional deployment but dynamically change in response to modulation of external factors such as manipulation of the visuospatial input during visuomotor adaptation.

Is recovery from left-sided neglect based on changes in automatic attention? An auditory event related potentials study

An automatic spatial attention deficit is the primary deficit in neglect. However, the cognitive processes enabling recovery from neglect have rarely been studied. We used event-related potentials (ERP) to analyze if recovery is based on changes in automatic attention components. Twelve sub-acute patients with left visuospatial neglect were included. They received 3 weeks of intensive treatment. ERPs were recorded using two auditory paradigms: either a tone was presented randomly to the right or left ear (ATP) or as a Posner paradigm (PP) with left to right and vice versa moving cue tones and validly and invalidly cued target tones. Patients improved significantly on neuropsychological tests and neurological scales. For the ATP, no differences were observed related to the side of stimulation, but the auditory PP showed characteristic results, that is, smaller amplitudes for left-sided targets and higher amplitudes for invalid trials. Both paradigms revealed a treatment effect, but no changes were found in the amplitudes for the two target sides, which would be expected if the treatment would affect the automatic attention bias. Recovery from neglect seems not to be associated with changes in the automatic spatial attention bias, arguing that recovery might be due to higher cognitive compensatory processes.

Does hand modulate the reshaping of the attentional system during rightward prism adaptation? An fMRI study

Adaptation to right-deviating prisms (R-PA), that is, learning to point with the right hand to targets perceived through prisms, has been shown to change spatial topography within the inferior parietal lobule (IPL) by increasing responses to left, central, and right targets on the left hemisphere and decreasing responses to right and central targets on the right hemisphere. As pointed out previously, this corresponds to a switch of the dominance of the ventral attentional network from the right to the left hemisphere. Since the encoding of hand movements in pointing paradigms is side-dependent, the choice of right vs. left hand for pointing during R-PA may influence the visuomotor adaptation process and hence the reshaping of the attentional system. We have tested this hypothesis in normal subjects by comparing activation patterns to visual targets in left, central, and right fields elicited before and after adaptation to rightward-deviating prisms using the right hand (RWRH) with those in two control groups. The first control group underwent adaptation to rightward-deviating prisms using the left hand, whereas the second control group underwent adaptation to leftward-deviating prisms using the right hand. The present study confirmed the previously described enhancement of left and central visual field representation within left IPL following R-PA. It further showed that the use of right vs. left hand during adaptation modulates this enhancement in some but not all parts of the left IPL. Interestingly, in some clusters identified in this study, L-PA with right hand mimics partially the effect of R-PA by enhancing activation elicited by left stimuli in the left IPL and by decreasing activation elicited by right stimuli in the right IPL. Thus, the use of right vs. left hand modulates the R-PA-induced reshaping of the ventral attentional system. Whether the choice of hand during R-PA affects also the reshaping of the dorsal attentional system remains to be determined as well as possible clinical applications of this approach. Depending on the patients' conditions, using the right or the left hand during PA might potentiate the beneficial effects of this intervention.

Choosing Sides: Impact of Prismatic Adaptation on the Lateralization of the Attentional System

Seminal studies revealed differences between the effect of adaptation to left- vs. right-deviating prisms (L-PA, R-PA) in normal subjects. Whereas L-PA leads to neglect-like shift in attention, demonstrated in numerous visuo-spatial and cognitive tasks, R-PA has only minor effects in specific aspects of a few tasks. The paucity of R-PA effects in normal subjects contrasts with the striking alleviation of neglect symptoms in patients with right hemispheric lesions. Current evidence from activation studies in normal subjects highlights the contribution of regions involved in visuo-motor control during prism exposure and a reorganization of spatial representations within the ventral attentional network (VAN) after the adaptation. The latter depends on the orientation of prisms used. R-PA leads to enhancement of the ipsilateral visual and auditory space within the left inferior parietal lobule (IPL), switching thus the dominance of VAN from the right to the left hemisphere. L-PA leads to enhancement of the ipsilateral space in right IPL, emphasizing thus the right hemispheric dominance of VAN. Similar reshaping has been demonstrated in patients. We propose here a model, which offers a parsimonious explanation of the effect of L-PA and R-PA both in normal subjects and in patients with hemispheric lesions. The model posits that prismatic adaptation induces instability in the synaptic organization of the visuo-motor system, which spreads to the VAN. The effect is lateralized, depending on the side of prism deviation. Successful pointing with prisms implies reaching into the space contralateral, and not ipsilateral, to the direction of prism deviation. Thus, in the hemisphere contralateral to prism deviation, reach-related neural activity decreases, leading to instability of the synaptic organization, which induces a reshuffling of spatial representations in IPL. Although reshuffled spatial representations in IPL may be functionally relevant, they are most likely less efficient than regular representations and may thus cause partial dysfunction. The former explains, e.g., the alleviation of neglect symptoms after R-PA in patients with right hemispheric lesions, the latter the occurrence of neglect-like symptoms in normal subjects after L-PA. Thus, opting for R- vs. L-PA means choosing the side of major IPL reshuffling, which leads to its partial dysfunction in normal subjects and to recruitment of alternative or enhanced spatial representations in patients with hemispheric lesions.

Using EEG to study sensorimotor adaptation

Sensorimotor adaptation, or the capacity to flexibly adapt movements to changes in the body or the environment, is crucial to our ability to move efficiently in a dynamic world. The field of sensorimotor adaptation is replete with rigorous behavioural and computational methods, which support strong conceptual frameworks. An increasing number of studies have combined these methods with electroencephalography (EEG) to unveil insights into the neural mechanisms of adaptation. We review these studies: discussing EEG markers of adaptation in the frequency and the temporal domain, EEG predictors for successful adaptation and how EEG can be used to unmask latent processes resulting from adaptation, such as the modulation of spatial attention. With its high temporal resolution, EEG can be further exploited to deepen our understanding of sensorimotor adaptation.

Visual but Not Auditory-Verbal Feedback Induces Aftereffects Following Adaptation to Virtual Prisms

Visuo-motor adaptation with optical prisms that displace the visual scene (prism adaptation, PA) has been widely used to study visuo-motor plasticity in healthy individuals and to decrease the lateralized bias of brain-damaged patients suffering from spatial neglect. Several factors may influence PA aftereffects, such as the degree of optical deviation (generally measured in dioptres of wedge prisms) or the direction of the prismatic shift (leftward vs. rightward). However, the mechanisms through which aftereffects of adaptation in healthy individuals and in neglect affect performance in tasks probing spatial cognition remain controversial. For example, some studies have reported positive effects of PA on auditory neglect, while other studies failed to obtain any changes of performance even in the visual modality. We here tested a new adaptation method in virtual reality to evaluate how sensory parameters influence PA aftereffects. Visual vs. auditory-verbal feedback of optical deviations were contrasted to assess whether rightward deviations influence manual and perceptual judgments in healthy individuals. Our results revealed that altered visual, but not altered auditory-verbal feedback induces aftereffects following adaptation to virtual prisms after 30-degrees of deviation. These findings refine current models of the mechanisms underlying the cognitive effects of virtual PA in emphasizing the importance of visual vs. auditory-verbal feedback during the adaptation phase on visuospatial judgments. Our study also specifies parameters which influence virtual PA and its aftereffect, such as the sensory modality used for the feedback.

Engagement of a parieto-cerebellar network in prism adaptation. A double-blind high-definition transcranial direct current stimulation study on healthy individuals

Prism Adaptation (PA) is a non-invasive method to investigate visuomotor control. Recent neurostimulation studies have proposed an interpretation of the mechanisms underlying PA based on functioning of brain networks, instead of focusing on single brain areas. To test the functioning of the network during a classical PA procedure, here we used for the first time High-Definition transcranial Direct Current Stimulation (HD-tDCS) to simultaneously inhibit or facilitate brain activity in two main nodes of the network, namely the parietal cortex and the cerebellum, in healthy individuals. The main results showed that simultaneous anodal HD-tDCS over the two regions reduced terminal errors during exposure to prism glasses as compared to cathodal and sham stimulation. Conversely, cathodal HD-tDCS reduced after-effect as compared to anodal and sham stimulation following prism removal. Overall, these results provide new insights on the network related to the deployment of PA mechanisms and demonstrate the feasibility of using non-invasive HD-tDCS to modulate the adaptive mechanisms of PA.

Bálint syndrome

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

How Does Attention Alter Length Perception? A Prism Adaptation Study

How perceived size (length) of an object is influenced by attention is in debate. Prism adaptation (PA), as a type of sensory motor adaptation, has been shown to affect performance on a variety of spatial tasks in both neglect patient and healthy individuals. It has been hypothesized that PA's effects might be mediated by attentional mechanisms. In this study, we used PA to laterally shift spatial attention, and employed a precise psychophysical procedure to examine how the perceptual length of lines was influenced by this attentional shifting. Participants were presented with two separate lines in the left and right visual fields, and compared the length of the two lines. Forty-five healthy participants completed this line-length judgment task before and after a short period of adaptation to either left- (Experiment 1) or right-shifting (Experiment 2) prisms, or control goggles that did not shift the visual scene (Experiment 3). We found that participants initially tended to perceive the line presented in the left to be longer. This leftward bias of length perception was reduced by a short period of visuomotor adaptation to the left-deviating PA. However, for the right-shifting PA and plain glass goggles conditions, the initial length perception bias to the left line was unaffected. Mechanisms of this asymmetric effect of PA was discussed. Our results demonstrate that the length perception of a line can be influenced by a simple visuomotor adaptation, which might shift the spatial attention. This finding is consistent with the argument that attention can alter appearance.

Saccadic Adaptation Boosts Ongoing Gamma Activity in a Subsequent Visuoattentional Task

Attention and saccadic adaptation (SA) are critical components of visual perception, the former enhancing sensory processing of selected objects, the latter maintaining the eye movements accuracy toward them. Recent studies propelled the hypothesis of a tight functional coupling between these mechanisms, possibly due to shared neural substrates. Here, we used magnetoencephalography to investigate for the first time the neurophysiological bases of this coupling and of SA per se. We compared visual discrimination performance of 12 healthy subjects before and after SA. Eye movements and magnetic signals were recorded continuously. Analyses focused on gamma band activity (GBA) during the pretarget period of the discrimination and the saccadic tasks. We found that GBA increases after SA. This increase was found in the right hemisphere for both postadaptation saccadic and discrimination tasks. For the latter, GBA also increased in the left hemisphere. We conclude that oculomotor plasticity involves GBA modulation within an extended neural network which persists after SA, suggesting a possible role of gamma oscillations in the coupling between SA and attention.

Distorted gaze direction input to attentional priority map in spatial neglect

A contribution of the gaze signals to the attention imbalance in spatial neglect is presumed. Direct evidence however, is still lacking. Theoretical models for spatial attention posit an internal representation of locations that are selected in the competition for neural processing resources – an attentional priority map. Following up on our recent research showing an imbalance in the allocation of attention after an oculoproprioceptive perturbation in healthy volunteers, we investigated here whether the lesion in spatial neglect distorts the gaze direction input to this representation.

Information about one's own direction of gaze is critical for the coordinate transformation between retinotopic and hand proprioceptive locations. To assess the gaze direction input to the attentional priority map, patients with left spatial neglect performed a cross-modal attention task in their normal, right hemispace. They discriminated visual targets whose location was cued by the patient's right index finger hidden from view. The locus of attention in response to the cue was defined as the location with the largest decrease in reaction time for visual discrimination in the presence vs. absence of the cue. In two control groups consisting of healthy elderly and patients with a right hemisphere lesion without neglect, the loci of attention were at the exact location of the cues. In contrast, neglect patients allocated attention at 0.5⁰-2⁰ rightward of the finger for all tested locations. A control task using reaching to visual targets in the absence of visual hand feedback ruled out a general error in visual localization. These findings demonstrate that in spatial neglect the gaze direction input to the attentional priority map is distorted. This observation supports the emerging view that attention and gaze are coupled and suggests that interventions that target gaze signals could alleviate spatial neglect.

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The mechanisms of left inattention in spatial neglect are incompletely understood.

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Attention loci in visual space are displaced to the right of somatosensory cues.

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This indicates a distorted gaze direction input to the attentional priority map.

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Distorted gaze direction input could lead to left-right attention imbalance.

Are eyes special? Electrophysiological and behavioural evidence for a dissociation between eye-gaze and arrows attentional mechanisms

It has been proposed that attention triggered by eye-gaze may represent a unique attentional process, different from that triggered by non-social stimuli such as arrows. To investigate this issue, in the present study we compared the temporal dynamics of the conflict processing triggered by eye-gaze and arrow stimuli. We investigated the electrophysiological activity during a task in which participants were required to identify the direction of laterally presented eye-gaze or arrow targets. Opposite behavioural effects were observed: while arrows produced the typical effect, with faster responses when they were congruent with their position, eye-gaze targets produced a reversed effect with faster responses when they were incongruent. Event-related potentials showed common and dissociable congruency modulation: whereas eye-gaze and arrows showed similar effects on earlier ERP components (P1 and N1), they led to opposite effects in later components such as N2 and P3. This represents the first electrophysiological demonstration of both early shared and later dissociable congruency effects for eye-gaze and arrow stimuli.

Pushing attention to one side: Force field adaptation alters neural correlates of orienting and disengagement of spatial attention

Sensorimotor adaptation to wedge prisms can alter the balance of attention between left and right space in healthy adults, and improve symptoms of spatial neglect after stroke. Here we asked whether the orienting of spatial attention to visual stimuli is affected by a different form of sensorimotor adaptation that involves physical perturbations of arm movement, rather than distortion of visual feedback. Healthy participants performed a cued discrimination task before and after they made reaching movements to a central target. A velocity-dependent force field pushed the hand aside during each reach, and required participants to apply compensatory forces toward the opposite side. We used event-related potentials (ERPs) to determine whether electroencephalography (EEG) responses reflecting orienting (cue-locked N1) and disengagement (target-locked P1) of spatial attention are affected by adaptation to force fields. After adaptation, the cue-locked N1 was relatively larger for stimuli presented in the hemispace corresponding to the direction of compensatory hand force. P1 amplitudes evoked by invalidly cued targets presented on the opposite side were reduced. This suggests that force field adaptation boosted attentional orienting responses toward the side of hand forces, and impeded attentional disengagement from that side, mimicking previously reported effects of prism adaptation. Thus, remapping between motor commands and intended movement direction is sufficient to bias ERPs, reflecting changes in the orienting of spatial attention in the absence of visuo-spatial distortion or visuo-proprioceptive mismatch. Findings are relevant to theories of how sensorimotor adaptation can modulate attention, and may open new avenues for treatment of spatial neglect.

Modifying and evaluating efficacy of interactive computerized program using motion tracking technology to improve unilateral neglect in patients with chronic stroke

BACKGROUND

To modify and evaluate the efficacy of a computerized visual perception rehabilitation program using interactive motion tracking technology with unilateral neglect after chronic stroke.

METHODS

Study design is single-blinded (analyst-blinded) controlled prospective clinical trial. Subjects are 16 patients with chronic stroke and unilateral neglect for over 6 months and 19 healthy volunteers. We modified our previous program to 9 tasks with built-in scoring system, and the subjects performed 3 sessions per week, 30 minutes per session for 4 weeks.

RESULTS

Scores for the Modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), Motor-free Visual Perception Test (MVPT), Line bisection test, Star cancellation test, Forward Digit Test, and Backward Digit Test showed significant improvement at the end of the sessions in the patient group. By comparing the parameters of built-in scoring system of each task among the control group, the first session of training in the patient group, and the last session of training in the patient group, we categorized the parameters for optional measurement to determine the effect of training or to be a candidate for evaluative use.

CONCLUSIONS

Our modified computerized visual perception rehabilitation program using improved unilateral neglect in patients post-stroke. Built-in scoring system in this program was helpful to assess availability of it more objectively.

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.

Adaptation to Leftward Shifting Prisms Alters Motor Interhemispheric Inhibition

Adaptation to rightward shifting prisms (rightward prism adaptation, RPA) ameliorates neglect symptoms in patients while adaptation to leftward shifting prisms (leftward prism adaptation, LPA) induces neglect-like behaviors in healthy subjects. It has been hypothesized that prism adaptation (PA) modulates interhemispheric balance between the parietal cortices by inhibiting the posterior parietal cortex (PPC) contralateral to the prismatic deviation, but PA's effects on interhemispheric inhibition (IHI) have not been directly investigated. Since there are hyper-excitable connections between the PPC and primary motor cortex (M1) in the left hemisphere of neglect patients, we reasoned that LPA might mimic right hemisphere lesions by reducing parietal IHI, hyper-exciting the left PPC and PPC-M1 connections, and in turn altering IHI at the motor level. Namely, we hypothesized that LPA would increase IHI from the left to the right M1. We examined changes in left-to-right and right-to-left IHI between the 2 M1s using the ipsilateral silent period (iSP) (Meyer et al. 1995) before and after either LPA or RPA. The iSP was significantly longer after LPA but only from left-to-right and it did not change at all after RPA. This is the first physiological demonstration that LPA alters IHI in the healthy brain.

Prismatic Adaptation Modulates Oscillatory EEG Correlates of Motor Preparation but Not Visual Attention in Healthy Participants

Prismatic adaption (PA) has been proposed as a tool to induce neural plasticity and is used to help neglect rehabilitation. It leads to a recalibration of visuomotor coordination during pointing as well as to aftereffects on a number of sensorimotor and attention tasks, but whether these effects originate at a motor or attentional level remains a matter of debate. Our aim was to further characterize PA aftereffects by using an approach that allows distinguishing between effects on attentional and motor processes. We recorded EEG in healthy human participants (9 females and 7 males) while performing a new double step, anticipatory attention/motor preparation paradigm before and after adaptation to rightward-shifting prisms, with neutral lenses as a control. We then examined PA aftereffects through changes in known oscillatory EEG signatures of spatial attention orienting and motor preparation in the alpha and beta frequency bands. Our results were twofold. First, we found PA to rightward-shifting prisms to selectively affect EEG signatures of motor but not attentional processes. More specifically, PA modulated preparatory motor EEG activity over central electrodes in the right hemisphere, contralateral to the PA-induced, compensatory leftward shift in pointing movements. No effects were found on EEG signatures of spatial attention orienting over occipitoparietal sites. Second, we found the PA effect on preparatory motor EEG activity to dominate in the beta frequency band. We conclude that changes to intentional visuomotor, rather than attentional visuospatial, processes underlie the PA aftereffect of rightward-deviating prisms in healthy participants.

SIGNIFICANCE STATEMENT Prismatic adaptation (PA) has been proposed as a tool to induce neural plasticity in both healthy participants and patients, due to its aftereffect impacting on a number of visuospatial and visuomotor functions. However, the neural mechanisms underlying PA aftereffects are poorly understood as only little neuroimaging evidence is available. Here, we examined, for the first time, the origin of PA aftereffects studying oscillatory brain activity. Our results show a selective modulation of preparatory motor activity following PA in healthy participants but no effect on attention-related activity. This provides novel insight into the PA aftereffect in the healthy brain and may help to inform interventions in neglect patients.

A Brief Exposure to Leftward Prismatic Adaptation Enhances the Representation of the Ipsilateral, Right Visual Field in the Right Inferior Parietal Lobule

A brief exposure to rightward prismatic adaptation (PA) was shown to shift visual field representation within the inferior parietal lobule (IPL) from the right to the left hemisphere. This change in hemispheric dominance could be interpreted as (1) a general effect of discrepancy in visuomotor alignment caused by PA or (2) a direction-specific effect of rightward PA. To test these hypotheses, we compared the effects of rightward and leftward PA on visual representation in normal human subjects. Three groups of normal subjects underwent an fMRI evaluation using a simple visual detection task before and after brief PA exposure using leftward- or rightward-deviating prisms or no prisms (L-PA, R-PA, neutral groups). A two-way ANOVA group × session revealed a significant interaction suggesting that PA-induced modulation is direction specific. Post hoc analysis showed that L-PA enhanced the representation of the right visual field within the right IPL. Thus, a brief exposure to L-PA enhanced right hemispheric dominance within the ventral attentional system, which is the opposite effect of the previously described shift in hemispheric dominance following R-PA. The direction-specific effects suggest that the underlying neural mechanisms involve the fine-tuning of specific visuomotor networks. The enhancement of right hemispheric dominance following L-PA offers a parsimonious explanation for neglect-like symptoms described previously in normal subjects.

Paired-Pulse Parietal-Motor Stimulation Differentially Modulates Corticospinal Excitability across Hemispheres When Combined with Prism Adaptation

Rightward prism adaptation ameliorates neglect symptoms while leftward prism adaptation (LPA) induces neglect-like biases in healthy individuals. Similarly, inhibitory repetitive transcranial magnetic stimulation (rTMS) on the right posterior parietal cortex (PPC) induces neglect-like behavior, whereas on the left PPC it ameliorates neglect symptoms and normalizes hyperexcitability of left hemisphere parietal-motor (PPC-M1) connectivity. Based on this analogy we hypothesized that LPA increases PPC-M1 excitability in the left hemisphere and decreases it in the right one. In an attempt to shed some light on the mechanisms underlying LPA's effects on cognition, we investigated this hypothesis in healthy individuals measuring PPC-M1 excitability with dual-site paired-pulse TMS (ppTMS). We found a left hemisphere increase and a right hemisphere decrease in the amplitude of motor evoked potentials elicited by paired as well as single pulses on M1. While this could indicate that LPA biases interhemispheric connectivity, it contradicts previous evidence that M1-only MEPs are unchanged after LPA. A control experiment showed that input-output curves were not affected by LPA per se. We conclude that LPA combined with ppTMS on PPC-M1 differentially alters the excitability of the left and right M1.