Dissociation of egocentric and allocentric coding of space in visual search after right middle cerebral artery stroke

A parcellation-based connectomic model of hemispatial neglect

BACKGROUND AND PURPOSE

Hemispatial neglect is characterized by a reduced awareness to stimuli on the contralateral side. Current literature suggesting that damage to the right parietal lobe and attention networks may cause hemispatial neglect is conflicting and can be improved by investigating a connectomic model of the "neglect system" and the anatomical specificity of regions involved in it.

METHODS

A meta-analysis of voxel-based morphometry magnetic resonance imaging (MRI) studies of hemispatial neglect was used to identify regions associated with neglect. We applied parcellation schemes to these regions and performed diffusion spectrum imaging (DSI) tractography to determine their connectivity. By overlaying neglect areas and maps of the attention networks, we studied the relationship between them.

RESULTS

The meta-analysis generated a list of 13 right hemisphere parcellations. These 13 neglect-related parcellations were predominantly linked by the superior longitudinal fasciculus (SLF) throughout a fronto-parietal-temporal network. We found that the dorsal and ventral attention networks showed partial overlap with the neglect system and included various other higher-order networks.

CONCLUSIONS

We provide an anatomically specific connectomic model of the neurobehavioral substrates underlying hemispatial neglect. Our model suggests a fronto-parietal-temporal network linked via the SLF supports the functions impaired in neglect and implicates various higher-order networks which are not limited to the attention networks.

Timing of Allocentric and Egocentric Spatial Processing in Human Intracranial EEG

Spatial reference frames (RFs) play a key role in spatial cognition, especially in perception, spatial memory, and navigation. There are two main types of RFs: egocentric (self-centered) and allocentric (object-centered). Although many fMRI studies examined the neural correlates of egocentric and allocentric RFs, they could not sample the fast temporal dynamics of the underlying cognitive processes. Therefore, the interaction and timing between these two RFs remain unclear. Taking advantage of the high temporal resolution of intracranial EEG (iEEG), we aimed to determine the timing of egocentric and allocentric information processing and describe the brain areas involved. We recorded iEEG and analyzed broad gamma activity (50-150 Hz) in 37 epilepsy patients performing a spatial judgment task in a three-dimensional circular virtual arena. We found overlapping activation for egocentric and allocentric RFs in many brain regions, with several additional egocentric- and allocentric-selective areas. In contrast to the egocentric responses, the allocentric responses peaked later than the control ones in frontal regions with overlapping selectivity. Also, across several egocentric or allocentric selective areas, the egocentric selectivity appeared earlier than the allocentric one. We identified the maximum number of egocentric-selective channels in the medial occipito-temporal region and allocentric-selective channels around the intraparietal sulcus in the parietal cortex. Our findings favor the hypothesis that egocentric spatial coding is a more primary process, and allocentric representations may be derived from egocentric ones. They also broaden the dominant view of the dorsal and ventral streams supporting egocentric and allocentric space coding, respectively.

Recent advances in treatment of spatial neglect: networks and neuropsychology

INTRODUCTION

Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development.

AREAS COVERED

This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal.

EXPERT OPINION

Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.

Altered functional activity in the right superior temporal gyrus in patients with definite vestibular migraine

BACKGROUND

Vestibular migraine (VM) is one of the most common causes of episodic central vestibular disorders; it is worth investigating whether VM belongs to the migraine subtype or is a separate disorder. The study is aimed at investigating resting-state functional brain activity alterations in patients with definite VM (dVM).

METHODS

Seventeen patients with dVM, 8 patients with migraine, and 17 health controls (HCs) were recruited. The amplitude of low frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were calculated to observe the changes in spontaneous brain activity.

RESULTS

Compared with HCs, VM patients showed significantly increased ALFF values in the right temporal lobe (P = 0.002) and increased ReHo values in the right superior, middle, and inferior temporal gyrus (STG, MTG, and ITG, P = 0.013); patients with migraine showed significantly increased ALFF values in the right limbic lobe (P = 0.04), left ITG (P = 0.024), and right frontal lobe (P < 0.001), significantly decreased ALFF values in the pons and brainstem (P = 0.013), and significantly decreased ReHo values in the frontal cortex (P < 0.001). Compared with patients with migraine, VM patients showed significantly increased fALFF values in the right parietal lobe (P = 0.011) and right frontal lobe (P = 0.026) and significantly increased ReHo values in the right thalamus (P = 0.043).

CONCLUSIONS

Patients with VM and migraine both had altered brain function, but the regions involved are different.

Task-related connectivity of decision points during spatial navigation in a schematic map

Successful navigation is largely dependent on the ability to make correct decisions at navigational decision points. However, the interaction between the brain regions associated with the navigational decision point in a schematic map is unclear. In this study, we adopted a 2D subway paradigm to study the neural basis underlying decision points. Twenty-eight subjects performed a spatial navigation task using a subway map during fMRI scanning. We adopted a voxel-wise general linear model (GLM) approach and found four brain regions, the left hippocampus (HIP), left parahippocampal gyrus (PHG), left ventromedial prefrontal cortex (vmPFC), and right retrosplenial cortex (RSC), activated at a navigational decision point in a schematic map. Using a psychophysiological interactions (PPI) method, we found that (1) both the left vmPFC and right HIP interacted cooperatively with the right RSC, and (2) the left HIP and the left vmPFC interacted cooperatively at the decision point. These findings may be helpful for revealing the neural mechanisms underlying decision points in a schematic map during spatial navigation.

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.

The 3s Spreadsheet Test version 2 for assessing egocentric viewer-centered and allocentric stimulus-centered spatial neglect

The present study established the norms of the 3 s Spreadsheet Test version 2 (3S-v2 Test) with 186 healthy adults, compared performance of 23 individuals with spatial neglect after right brain stroke to the norms, and examined the extent that allocentric neglect is independent from egocentric neglect. The task required in the 3S-v2 Test is to cross out the target digit "3" in a spreadsheet that contained 10 columns and 14 rows of digit strings, including 120 target digits and 720 non-target digits. Each target is categorized with respect to its location on the page (egocentric viewer-centered) and its position within the digit string (allocentric stimulus-centered). Patients completed the 3S-v2 Test, the Apples Test, and Scene Copying Test (a five-object figure copying test). Based on the neglect classification criteria of these three tests, 18 patients (78.3%) were identified with both forms of neglect, three patients (13.0%) had isolated egocentric neglect, and two (8.7%) had isolated allocentric neglect. Among patients who were determined as having allocentric neglect by a given test, we found no significant correlation between severity of allocentric neglect and stimulus location in the egocentric reference frame. Based on the present findings, we suggest that including the 3S-v2 Test, a functionally relevant task and different from the currently available tests, may increase the comprehensiveness of neglect assessment. In addition, allocentric neglect symptoms are independent of egocentric locations.

The use of egocentric and allocentric reference frames in static and dynamic conditions in humans

The dissociation between egocentric and allocentric reference frames is well established. Spatial coding relative to oneself has been associated with a brain network distinct from spatial coding using a cognitive map independently of the actual position. These differences were, however, revealed by a variety of tasks from both static conditions, using a series of images, and dynamic conditions, using movements through space. We aimed to clarify how these paradigms correspond to each other concerning the neural correlates of the use of egocentric and allocentric reference frames. We review here studies of allocentric and egocentric judgments used in static two- and three-dimensional tasks and compare their results with the findings from spatial navigation studies. We argue that neural correlates of allocentric coding in static conditions but using complex three-dimensional scenes and involving spatial memory of participants resemble those in spatial navigation studies, while allocentric representations in two-dimensional tasks are connected with other perceptual and attentional processes. In contrast, the brain networks associated with the egocentric reference frame in static two-dimensional and three-dimensional tasks and spatial navigation tasks are, with some limitations, more similar. Our review demonstrates the heterogeneity of experimental designs focused on spatial reference frames. At the same time, it indicates similarities in brain activation during reference frame use despite this heterogeneity.

Dynamic Causal Modelling of Active Vision

In this paper, we draw from recent theoretical work on active perception, which suggests that the brain makes use of an internal (i.e., generative) model to make inferences about the causes of sensations. This view treats visual sensations as consequent on action (i.e., saccades) and implies that visual percepts must be actively constructed via a sequence of eye movements. Oculomotor control calls on a distributed set of brain sources that includes the dorsal and ventral frontoparietal (attention) networks. We argue that connections from the frontal eye fields to ventral parietal sources represent the mapping from “where”, fixation location to information derived from “what” representations in the ventral visual stream. During scene construction, this mapping must be learned, putatively through changes in the effective connectivity of these synapses. Here, we test the hypothesis that the coupling between the dorsal frontal cortex and the right temporoparietal cortex is modulated during saccadic interrogation of a simple visual scene. Using dynamic causal modeling for magnetoencephalography with (male and female) human participants, we assess the evidence for changes in effective connectivity by comparing models that allow for this modulation with models that do not. We find strong evidence for modulation of connections between the two attention networks; namely, a disinhibition of the ventral network by its dorsal counterpart.

SIGNIFICANCE STATEMENT This work draws from recent theoretical accounts of active vision and provides empirical evidence for changes in synaptic efficacy consistent with these computational models. In brief, we used magnetoencephalography in combination with eye-tracking to assess the neural correlates of a form of short-term memory during a dot cancellation task. Using dynamic causal modeling to quantify changes in effective connectivity, we found evidence that the coupling between the dorsal and ventral attention networks changed during the saccadic interrogation of a simple visual scene. Intuitively, this is consistent with the idea that these neuronal connections may encode beliefs about “what I would see if I looked there”, and that this mapping is optimized as new data are obtained with each fixation.

Interactions between egocentric and allocentric spatial coding of sounds revealed by a multisensory learning paradigm

Although sound position is initially head-centred (egocentric coordinates), our brain can also represent sounds relative to one another (allocentric coordinates). Whether reference frames for spatial hearing are independent or interact remained largely unexplored. Here we developed a new allocentric spatial-hearing training and tested whether it can improve egocentric sound-localisation performance in normal-hearing adults listening with one ear plugged. Two groups of participants (N = 15 each) performed an egocentric sound-localisation task (point to a syllable), in monaural listening, before and after 4-days of multisensory training on triplets of white-noise bursts paired with occasional visual feedback. Critically, one group performed an allocentric task (auditory bisection task), whereas the other processed the same stimuli to perform an egocentric task (pointing to a designated sound of the triplet). Unlike most previous works, we tested also a no training group (N = 15). Egocentric sound-localisation abilities in the horizontal plane improved for all groups in the space ipsilateral to the ear-plug. This unexpected finding highlights the importance of including a no training group when studying sound localisation re-learning. Yet, performance changes were qualitatively different in trained compared to untrained participants, providing initial evidence that allocentric and multisensory procedures may prove useful when aiming to promote sound localisation re-learning.

The different association of allocentric and egocentric neglect with dorsal and ventral pathways: A case report

RATIONALE

Egocentric neglect is characterized by responses missing on the contralateral side with respect to the viewer, while allocentric neglect is characterized in responses missing on the contralateral side with respect to the object . However, little has been reported about the neural tracts associated with egocentric and allocentric neglect. We investigated which neural tracts were involved in two types of neglect (egocentric and allocentric) in a stroke patient who showed allocentric neglect by using the Apple Cancellation test, a specialized test to distinguish between egocentric and allocentric neglect.

PATIENT CONCERNS

He showed good cognitive function but presented with severe neglect on the left side (A 42-year-old, right-handed male patient). He was unable to undergo even the pencil and paper test for evaluation of the severity of neglect.

DIAGNOSES

He was diagnosed as spontaneous intracerebral hemorrhage at the right basal ganglia and underwent conservative management at the neurosurgery department of a university hospital.

INTERVENTIONS

Two weeks after onset, he began rehabilitation at the rehabilitation department of the same university hospital. During a seven month rehabilitation, the patient showed significant improvement of his severe left neglect.

OUTCOMES

We used the Apple Cancellation test to distinguish between egocentric and allocentric neglect; the results failed to reveal egocentric neglect, however, they did reveal severe allocentric neglect. In addition, on diffusion tensor tractography (DTT) at 2 weeks after onset, the right superior longitudinal fasciculus (SLF) showed partial injury and narrowing in the parietal lobe compared to that of the left SLF. In addition, the right inferior fronto-occipital fasciculus (IFOF) was not reconstructed. By contrast, on 7-month post-onset DTT, the right SLF revealed elongation and thickening in the parietal lobe that approached similarity to that for the left SLF. However, the right IFOF was still not reconstructed.

LESSONS

The associations of egocentric neglect with the dorsal pathway (SLF) and the association of allocentric neglect with the ventral pathway (IFOF) in the right hemisphere were demonstrated in a stroke patient. It appears that DTT can be helpful in demonstrating both the affected pathway and the neglect type in patients with neglect.

Right Hemisphere Cognitive Functions: From Clinical and Anatomic Bases to Brain Mapping During Awake Craniotomy Part I: Clinical and Functional Anatomy

The nondominant hemisphere (usually the right) is responsible for primary cognitive functions such as visuospatial and social cognition. Awake surgery using direct electric stimulation for right cerebral tumor removal remains challenging because of the complexity of the functional anatomy and difficulties in adapting standard bedside tasks to awake surgery conditions. An understanding of semiology and anatomic bases, along with an analysis of the available cognitive tasks for visuospatial and social cognition per operative mapping allow neurosurgeons to better appreciate the functional anatomy of the right hemisphere and its relevance to tumor surgery. In this article, the first of a 2-part review, we discuss the anatomic and functional basis of right hemisphere function. Whereas part II of the review focuses primarily on semiology and surgical management of right-sided tumors under awake conditions, this article provides a comprehensive review of knowledge underpinning awake surgery on the right hemisphere.

The role of the right superior temporal gyrus in stimulus-centered spatial processing

Although emerging neuropsychological evidence supports the involvement of temporal areas, and in particular the right superior temporal gyrus (STG), in allocentric neglect deficits, the role of STG in healthy spatial processing remains elusive. While several functional brain imaging studies have demonstrated involvement of the STG in tasks involving explicit stimulus-centered judgments, prior rTMS studies targeting the right STG did not find the expected neglect-like rightward bias in size judgments using the conventional landmark task. The objective of the current study was to investigate whether disruption of the right STG using inhibitory repetitive transcranial magnetic stimulation (rTMS) could impact stimulus-centered, allocentric spatial processing in healthy individuals. A lateralized version of the landmark task was developed to accentuate the dissociation between viewer-centered and stimulus-centered reference frames. We predicted that inhibiting activity in the right STG would decrease accuracy because of induced rightward bias centered on the line stimulus irrespective of its viewer-centered or egocentric locations. Eleven healthy, right-handed adults underwent the lateralized landmark task. After viewing each stimulus, participants had to judge whether the line was bisected, or whether the left (left-long trials) or the right segment (right-long trials) of the line was longer. Participants repeated the task before (pre-rTMS) and after (post-rTMS) receiving 20 min of 1 Hz rTMS over the right STG, the right supramarginal gyrus (SMG), and the vertex (a control site) during three separate visits. Linear mixed models for binomial data were generated with either accuracy or judgment errors as dependent variables, to compare 1) performance across trial types (bisection, non-bisection), and 2) pre- vs. post-rTMS performance between the vertex and the STG and the vertex and the SMG. Line eccentricity (z = 4.31, p < 0.0001) and line bisection (z = 5.49, p < 0.0001) were significant predictors of accuracy. In the models comparing the effects of rTMS, a significant two-way interaction with STG (z = -3.09, p = 0.002) revealed a decrease in accuracy of 9.5% and an increase in errors of the right-long type by 10.7% on bisection trials, in both left and right viewer-centered locations. No significant changes in leftward errors were found. These findings suggested an induced stimulus-centered rightward bias in our participants after STG stimulation. Notably, accuracy or errors were not influenced by SMG stimulation compared to vertex. In line with our predictions, the findings provide compelling evidence for right STG's involvement in healthy stimulus-centered spatial processing.

The Computational Anatomy of Visual Neglect

Visual neglect is a debilitating neuropsychological phenomenon that has many clinical implications and-in cognitive neuroscience-offers an important lesion deficit model. In this article, we describe a computational model of visual neglect based upon active inference. Our objective is to establish a computational and neurophysiological process theory that can be used to disambiguate among the various causes of this important syndrome; namely, a computational neuropsychology of visual neglect. We introduce a Bayes optimal model based upon Markov decision processes that reproduces the visual searches induced by the line cancellation task (used to characterize visual neglect at the bedside). We then consider 3 distinct ways in which the model could be lesioned to reproduce neuropsychological (visual search) deficits. Crucially, these 3 levels of pathology map nicely onto the neuroanatomy of saccadic eye movements and the systems implicated in visual neglect.

A study on the independence of egocentric and allocentric neglect

Currently there seems to be consensus that visuospatial neglect may involve egocentric and allocentric symptoms. However, the relation between the two is still discussed and models have been proposed based on the high correlation between allocentric and egocentric neglect symptoms. To analyze the relation between these two kinds of symptoms we developed a new paradigm. In contrast to previous paradigms, we varied the extension of the search field and we added centered reference targets to evaluate egocentric effects independent from allocentric effects. Patients with exclusively left-sided neglect (n = 15) and left-sided visual field deficit (VFD) (n = 9) were included. Right brain damaged patients (n = 15) and a healthy control (n = 15) acted as control groups. The results revealed egocentric inattention in VFD patients. Neglect patients suffered from egocentric and allocentric neglect, but we found no interaction between both kinds of impairments in the sense of a monotonous additive or multiplicative increase going from right to left in terms of egocentric and allocentric coordinates. On the contrary, at the outmost left allocentric and egocentric positions, the number of omissions did not increase, unlike in outmost right and centered positions. In conclusion, our experiment shows that egocentric and allocentric neglect can be clearly dissociated in neglect patients and do not interact. Inclusion of neglect patients with a VFD may lead to an artificial interaction between egocentric and allocentric symptoms and this may explain the differences with results of previous studies.

Navigation strategies as revealed by error patterns on the Magic Carpet test in children with cerebral palsy

Introduction: Short-term memory develops differently in navigation vs. manual space. The Magic Carpet (MC) is a novel navigation test derived from the Walking Corsi Test and the manual Corsi Block-tapping Task (CBT). The MC requires mental rotations and executive function. In Cerebral Palsy (CP), CBT, and MC scores relate differently to clinical and lesional factors. Hypotheses of this study are: that frontal lesion specifically affect navigation in CP; that brain lesions affect MC cognitive strategies.

Materials and Methods: Twenty-two children with spastic CP, aged 5 to 14 years, 14 with a unilateral and 8 with a bilateral form, underwent the CBT and the MC. Errors were classified into seven patterns by a recently described algorithm. Brain lesions were quantified according to a novel semi-quantitative MRI scale. Control data were partially drawn from a previous study on 91 typically developing children.

Results: Children with CP performed worse than controls on both tests. Right hemispheric impairment correlated with spatial memory. MC span was reduced less than CBT span and was more selectively related to right middle white-matter and frontal lesions. Error patterns were differently distributed in CP and in typical development, and depended on right brain impairment: children with more extensive right lesions made more positional than sequential errors.

Discussion: In CP, navigation is affected especially by extensive lesions involving the right frontal lobe. In addition, these are associated with abnormal cognitive strategies. Whereas in typical development positional errors, preserving serial order, increase with age and performance, in CP they are associated with poorer performance and more extensive right-brain lesions. The explanation may lie in lesion side: right brain is crucial for mental rotations, necessary for spatial updating. Left-lateralized spatial memory strategies, relying on serial order, are not efficient if not accompanied by right-brain spatial functions.

Lesion Sites Associated with Allocentric and Egocentric Visuospatial Neglect in Acute Stroke

Visuospatial neglect is a disorder that can often result from stroke and is characterized by an inability to attend to contralesional stimuli. Two common subtypes include allocentric (object-centered) neglect and egocentric (viewer-centered) neglect. In allocentric neglect, spatial inattention is localized to the contralesional side of an object regardless of its relative position to the observer. In egocentric neglect, spatial inattention is localized to the contralesional side of the individual's midline. The neuroanatomical correlates of each subtype are unknown. However, recent work has suggested that damage to temporal, inferior parietal, and occipital areas may result in allocentric neglect and that damage to frontoparietal areas may result in egocentric neglect. We used voxel-based lesion-symptom mapping (VLSM) to compare lesion location to behavioral performance on the conventional six subtests of the Behavioral Inattention Test (BIT) in 62 subjects with acute right hemisphere ischemic stroke. Results identified an anatomical dissociation in lesion location between subjects with neglect based on poor performance on allocentric tests (line bisection, copying, and drawing tasks) and on egocentric tests (star, letter, and line cancellation). VLSM analyses revealed that poor performance on the allocentric tests was associated with lesions to the superior and inferior parietal cortices, and the superior and middle temporal gyri. In contrast, poor performance on the egocentric tests was associated with lesions in the precentral gyrus, middle frontal gyrus, insula, and putamen. Interestingly, the letter cancellation test and average performance on egocentric tests were associated with frontal and parietal lesions. Some of these parietal lesion locations overlapped with lesion locations associated with allocentric neglect. These findings are consistent with suggestions that damage to temporal and parietal areas is more associated with allocentric neglect and damage to frontal lobe areas is more associated with egocentric neglect.

Italian standardization of the Apples Cancellation Test

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect).

Long-term effects of continuous theta-burst stimulation in visuospatial neglect

Objective

To investigate whether the efficacy of continuous theta-burst stimulation (cTBS) for improving visuospatial neglect can be enhanced by providing more days of stimulation and more stimulation trains per day.

Methods

In a prospective study, right-handed patients with right hemisphere stroke and visuospatial neglect were randomized to cTBS or sham cTBS treatment for 2 weeks and were followed up for 4 weeks. The cTBS group received active cTBS over the posterior parietal cortex of the unaffected hemisphere, combined with conventional rehabilitation therapy. Changes in scores for two paper–pencil tests for visuospatial neglect (star cancellation and line bisection) were evaluated.

Results

In each group, 10 patients completed follow up. Compared with the sham group, star cancellation test scores in the cTBS group were improved by 37.03% at the end of treatment and by 47.21% after 4 weeks’ follow up, and the line bisection score improved by 21.37% at the end of treatment and by 35.99% after 4 weeks’ follow up.

Conclusions

These results suggest that the efficacy of cTBS in visuospatial neglect can be enhanced and prolonged by increasing the days of stimulation and the number of stimulation trains per day over the left posterior parietal cortex.

Dissociating the neural mechanisms of distance and spatial reference frames

This study investigated if the neural mechanisms involved in processing distance (near and far) and frame of reference (egocentric and allocentric) can be dissociated. 36 participants completed a conjunction visual search task using either an egocentric (deciding if the target was to their left or right) or an allocentric (deciding if the target was to the left or right of a reference object) frame. Both tasks were performed in near (57 cm) and far (171 cm) space conditions. Participants were separated into three groups, and each received transcranial magnetic stimulation (TMS) to a different site; right posterior parietal cortex (rPPC), right ventral occipital cortex (rVO), or right frontal eye field (rFEF) in addition to sham TMS. The results show that rFEF is critical in the processing of each search at each distance whereas, contrary to previous detection results, TMS over rVO did not affect performance for any condition. TMS over rPPC revealed that specialised egocentric processing in the parietal cortex does not generalise to far space, providing evidence of a separation of the reference frame/distance conflation in the literature.

Functional assessment of region-specific neglect: are there differential behavioural consequences of peripersonal versus extrapersonal neglect?

BACKGROUND

Region-specific types of neglect (peripersonal and extrapersonal) have been dissociated, yet, differential behavioural consequences are unknown.

OBJECTIVE

The aim of the current study was to investigate behavioural consequences at the level of basic activities of daily living of region-specific neglect, using the Catherine Bergego Scale (CBS).

METHODS

118 stroke patients were screened within the first two weeks after admission to the rehabilitation center for inpatient rehabilitation.

RESULTS

Patients with peripersonal neglect and patients with neglect for both regions had significantly higher total score on the CBS compared to nonneglect patients. Total scores for patients with extrapersonal neglect were comparable to non-neglect patients. ADL impairments were found across activities (e.g., looking towards one side, forgetting body parts, colliding) for both patients with peripersonal neglect and patients with neglect for both regions. Patients with extrapersonal neglect were only impaired on the item on way finding.

CONCLUSIONS

When diagnosing neglect, it is relevant to distinguish the type of region-specific neglect and, where needed, to adjust the rehabilitation program accordingly. As the CBS is not developed to typically measure ADL in extrapersonal neglect, it would be of importance to add other (instrumental) activities that heavily rely on processing information in farther space.

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.

Transcranial direct current stimulation accelerates allocentric target detection

BACKGROUND

Previous research on hemispatial neglect has provided evidence for dissociable mechanisms for egocentric and allocentric processing. Although a few studies have examined whether tDCS to posterior parietal cortex can be beneficial for attentional processing in neurologically intact individuals, none have examined the potential effect of tDCS on allocentric and/or egocentric processing.

OBJECTIVE/HYPOTHESIS

Our objective was to examine whether transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique that can increase (anodal) or decrease (cathodal) cortical activity, can affect visuospatial processing in an allocentric and/or egocentric frame of reference.

METHODS

We tested healthy individuals on a target detection task in which the target--a circle with a gap--was either to the right or left of the viewer (egocentric), or contained a gap on the right or left side of the circle (allocentric). Individuals performed the task before, during, and after tDCS to the posterior parietal cortex in one of three stimulation conditions--right anodal/left cathodal, right cathodal/left anodal, and sham.

RESULTS

We found an allocentric hemispatial effect both during and after tDCS, such that right anodal/left cathodal tDCS resulted in faster reaction times for detecting stimuli with left-sided gaps compared to right-sided gaps.

CONCLUSIONS

Our study suggests that right anodal/left cathodal tDCS has a facilitatory effect on allocentric visuospatial processing, and might be useful as a therapeutic technique for individuals suffering from allocentric neglect.

Assessment and functional impact of allocentric neglect: a reminder from a case study

SR suffered a right hemispheric stroke more than 3 years ago, and now lives with left-sided hemiparesis and chronic spatial neglect due to damaged white matter pathways connecting the frontal, temporal and parietal regions. We report here that SR suffers from both viewer-centered (i.e., egocentric) and object-centered (i.e., allocentric) spatial neglect. Notably, unlike most neuropsychological and functional assessments that focus on egocentric deficits, a specialized neuropsychological figurative discrimination test (the Apples test) revealed SR's allocentric neglect. Further, using assessments sensitive to detect functional deficits related to allocentric neglect, we observed SR's difficulty in reading and using clocks, reflecting his object-centered errors in these everyday activities. SR's case suggests that allocentric-specific assessments, both neuropsychological and functional, are valuable in standard neglect examinations, particularly to predict daily function after stroke. We recommend that neglect-related functional disability be distinguished further with respect to allocentric spatial deficits, and functional assessments for allocentric neglect should be validated in future large sample studies. Identifying allocentric neglect early, and learning about its influence on daily function, may enhance care quality and facilitate effective rehabilitation planning for stroke recovery.

Prism Adaptation Improves Ego-Centered but Not Allocentric Neglect in Early Rehabilitation Patients

Background and Objective. Unilateral neglect due to parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, and prism adaptation (PA) enhances recovery from neglect. However, it is unclear if this effect holds also in severely impaired patients and/or in the postacute phase of rehabilitation. Moreover, it is not known whether PA affects all aspects of neglect recovery or ego-centered spatial orientation only. Methods. Sixteen patients in a postacute stage (on average 36 days after a large right cerebrovascular stroke) were entered into a series of single case design studies with 4 measurements: 2 before and 2 after 1 week of PA treatment. All patients had severe neglect (showing trunk, head, and eye deviation; canceling less than 20% of targets in a visual cancellation test). Lesions were transferred to a standard brain to analyze size and location. Results. Patients improved in cued body orientation and in the cancellation task, that is, in ego-centered neglect. However, none of the measures used to evaluate neglect of left side of objects irrespective of their position on the right or left side of the patient (allocentric neglect) showed an improvement. Treatment effects were not influenced by total lesion size, but lesions including the postcentral cortex were related to smaller recovery gains. Conclusion. PA is helpful in treating severely impaired patients in the postacute phase, but the effect is restricted to ego-centered neglect. Lesions in the postcentral cortex (middle occipito-temporal, middle temporal, and posterior parietal areas) seem to limit the effect of PA.

Object-based neglect in number processing

Recent evidence suggests that neglect patients seem to have particular problems representing relatively smaller numbers corresponding to the left part of the mental number line. However, while this indicates space-based neglect for representational number space little is known about whether and - if so - how object-based neglect influences number processing.

To evaluate influences of object-based neglect in numerical cognition, a group of neglect patients and two control groups had to compare two-digit numbers to an internally represented standard. Conceptualizing two-digit numbers as objects of which the left part (i.e., the tens digit should be specifically neglected) we were able to evaluate object-based neglect for number magnitude processing.

Object-based neglect was indicated by a larger unit-decade compatibility effect actually reflecting impaired processing of the leftward tens digits. Additionally, faster processing of within- as compared to between-decade items provided further evidence suggesting particular difficulties in integrating tens and units into the place-value structure of the Arabic number system.

In summary, the present study indicates that, in addition to the spatial representation of number magnitude, also the processing of place-value information of multi-digit numbers seems specifically impaired in neglect patients.

Egocentric and allocentric spatial representations in Williams syndrome

Williams syndrome (WS) is a neurodevelopmental disorder characterized by severe visuospatial deficits, particularly affecting spatial navigation and wayfinding. Creating egocentric (viewer-dependent) and allocentric (viewer-independent) representations of space is essential for the development of these abilities. However, it remains unclear whether egocentric and allocentric representations are impaired in WS. In this study, we investigate egocentric and allocentric frames of reference in this disorder. A WS group (n = 18), as well as a chronological age-matched control group (n = 20), a non-verbal mental age-matched control group (n = 20) and a control group with intellectual disability (n = 17), was tested with a computerized and a 3D spatial judgment task. The results showed that WS participants are impaired when performing both egocentric and allocentric spatial judgments even when compared with mental age-matched control participants. This indicates that a substantial deficit affecting both spatial representations is present in WS. The egocentric impairment is in line with the dorsal visual pathway deficit previously reported in WS. Interestingly, the difficulties found in performing allocentric spatial judgments give important cues to better understand the ventral visual functioning in WS.

Is 'object-centred neglect' a homogeneous entity?

The nature of object-centred (allocentric) neglect and the possibility of dissociating it from egocentric (subject-centred) forms of neglect are controversial. Originally, allocentric neglect was described by Gainotti, D'Erme, Monteleone & Silveri (1986) and Gainotti, Messerli, & Tissot (1972) in patients who reproduced all the elements of a multi-object scene, but left unfinished the left side of one or more of them. More recently, however, Karnath, Mandler, and Clavagnier (2011) have claimed that the severity of allocentric neglect worsens when a complex 'object' shifts from an ipsilesional to a contralesional egocentric position. On the basis of these and of other clinical data, showing that allocentric and egocentric neglect are strongly associated, they have questioned the possibility of dissociating these two forms of neglect, suggesting that egocentric and allocentric neglect constitute different manifestations of the same disturbed system. Since these statements were inconsistent with the clinical findings which had prompted the construct of object-centred neglect, we checked in a group of right brain-damaged patients, who had copied the original multi-object scene, if the degree of neglect for the left side of figures varied as a function of their position on the horizontal axis. Furthermore, we reviewed all papers where copies of other multi-object scenes had been reported. Results of both studies failed to confirm the assumption of a relationship between spatial location of the stimulus and severity of object-centred neglect. This discrepancy between our data and those obtained by Karnath et al. (2011) could be due to the characteristics of stimuli and of procedures used to evaluate 'object-centred' neglect. If the stimulus is complex and the task requires its thorough exploration, the spatial location of the stimulus will influence the severity of 'object-centred neglect'. If, on the contrary, the stimulus is simple and can be identified with few eye fixations, the spatial location of the stimulus should not influence the severity of 'object-centred neglect'. In any case, our data confirm the possibility of dissociating allocentric from egocentric neglect.

Neuroanatomical Dissections of Unilateral Visual Neglect Symptoms: ALE Meta-Analysis of Lesion-Symptom Mapping

Unilateral visual neglect is commonly defined as impaired ability to attend to stimuli presented on the side of visual space contralateral to the brain lesion. However, behavioral analyses indicate that different neglect symptoms can dissociate. The neuroanatomy of the syndrome has been hotly debated. Some groups have argued that the syndrome is linked to posterior parietal cortex lesions, while others report damage within regions including the superior temporal gyrus, insula, and basal ganglia. Several recent neuroimaging studies provide evidence that heterogeneity in the behavioral symptoms of neglect can be matched by variations in the brain lesions, and that some of the discrepancies across earlier findings might have resulted from the use of different neuropsychological tests and/or varied measures within the same task for diagnosing neglect. In this paper, we review the evidence for dissociations between both the symptoms and the neural substrates of unilateral visual neglect, drawing on ALE (anatomic likelihood estimation) meta-analyses of lesion-symptom mapping studies. Specifically, we examine dissociations between neglect symptoms associated with impaired control of attention across space (in an egocentric frame of reference) and within objects (in an allocentric frame of reference). Results of ALE meta-analyses indicated that, while egocentric symptoms are associated with damage within perisylvian network (pre- and postcentral, supramarginal, and superior temporal gyri) and damage within sub-cortical structures, more posterior lesions including the angular, middle temporal, and middle occipital gyri are associated with allocentric symptoms. Furthermore, there was high concurrence in deficits associated with white matter lesions within long association (superior longitudinal, inferior fronto-occipital, and inferior longitudinal fasciculi) and projection (corona radiata and thalamic radiation) pathways, supporting a disconnection account of the syndrome. Using this evidence we argue that different forms of neglect link to both distinct and common patterns of gray and white matter lesions. The findings are discussed in terms of functional accounts of neglect and theoretical models based on computational studies of both normal and impaired attention functions.

Is there a critical lesion site for unilateral spatial neglect? A meta-analysis using activation likelihood estimation

The critical lesion site responsible for the syndrome of unilateral spatial neglect has been debated for more than a decade. Here we performed an activation likelihood estimation (ALE) to provide for the first time an objective quantitative index of the consistency of lesion sites across anatomical group studies of spatial neglect. The analysis revealed several distinct regions in which damage has consistently been associated with spatial neglect symptoms. Lesioned clusters were located in several cortical and subcortical regions of the right hemisphere, including the middle and superior temporal gyrus, inferior parietal lobule, intraparietal sulcus, precuneus, middle occipital gyrus, caudate nucleus, and posterior insula, as well as in the white matter pathway corresponding to the posterior part of the superior longitudinal fasciculus. Further analyses suggested that separate lesion sites are associated with impairments in different behavioral tests, such as line bisection and target cancellation. Similarly, specific subcomponents of the heterogeneous neglect syndrome, such as extinction and allocentric and personal neglect, are associated with distinct lesion sites. Future progress in delineating the neuropathological correlates of spatial neglect will depend upon the development of more refined measures of perceptual and cognitive functions than those currently available in the clinical setting.

Study on the occurrence and neural bases of hemispatial neglect with different reference frames

OBJECTIVES

To study the distributions and the neural correlates of left hemispatial neglect with different reference frames.

DESIGN

Data were collected from patients with right brain injury who participated in a case series.

SETTING

Hospital departments of rehabilitation and neurology.

PARTICIPANTS

Right brain-damaged patients (N=110).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The frequency of left hemispatial neglect with different reference frames was investigated, and the respective brain lesions were displayed and analyzed.

RESULTS

Not all subjects finished predesigned neglect tests because of their condition: 8 of the 55 neglect patients were unable to complete the test for classification. Thirty (63.83%) of 47 subjects with neglect displayed both allocentric and egocentric neglect, while 17 subjects showed pure egocentric neglect. The lesions in the inferior frontal gyrus, precentral gyrus, postcentral gyrus, superior temporal gyrus (STG), middle temporal gyrus (MTG), insula, and surrounding white matters were more frequent in the neglect group than in the control group. Compared with the egocentric neglect group, the lesions in the right STG, MTG, lenticular nucleus, and the surrounding white matter were damaged more frequently in the group displaying both allocentric and egocentric neglect.

CONCLUSIONS

More than half of the subjects with left neglect after right brain injury have both egocentric and allocentric neglect. The right inferior frontal gyrus, precentral gyrus, postcentral gyrus, STG, MTG, insula, and the surrounding white matter are associated with left hemispatial neglect. Left allocentric neglect is associated with the right STG, MTG, and lenticular nucleus.

Object-based Neglect Varies with Egocentric Position

Different reference frames have been identified to influence neglect behavior. In particular, neglect has been demonstrated to be related to the contralesional side of the subject's body (egocentric reference frames) as well as to the contralesional side of individual objects irrespective of their position to the patient (object-based reference frame). There has been discussion whether this distinction separates neglect into body- and object-based forms. The present experiment aimed to prove possible interactions between object-based and egocentric aspects in spatial neglect. Neglect patients' eye and head movements were recorded while they explored objects at five egocentric positions along the horizontal dimension of space. The patients showed both egocentric as well as object-based behavior. Most interestingly, data analysis revealed that object-based neglect varied with egocentric position. Although the neglect of the objects' left side was strong at contralesional egocentric positions, it ameliorated at more ipsilesional egocentric positions of the objects. The patients showed steep, ramp-shaped patterns of exploration for objects located on the far contralesional side and a broadening of these patterns as the locations of the objects shifted more to the ipsilesional side. The data fitted well with the saliency curves predicted by a model of space representation, which suggests that visual input is represented in two modes simultaneously: in veridical egocentric coordinates and in within-object coordinates.

The anatomy of spatial neglect

Spatial neglect is often perceived as a "heterogeneous collection of symptoms" with controversial anatomical correlates. However, a clear framework for core and satellite symptoms exists. Here we review the literature when viewed from the perspective of these different syndromes, and find clear pattern of anatomical injury. Specifically, the combined symptoms of biased gaze direction and search - with no awareness of these symptoms-is seen following structural damage to (particularly right hemisphere) perisylvian regions. Object centered deficits such as biased line bisection are due to more posterior (and possibly inferior) injury. Finally, extinction is associated with damage to the temporo-parietal junction. Further, we describe key choices that must be made to parse the spatial and attentional syndromes that result from right hemisphere injury, including the investigation of both acute and chronic injury as well as the use of functional and structural modalities.

Visual neglect following stroke: current concepts and future focus

Visual neglect is a common, yet frequently overlooked, neurological disorder following stroke characterized by a deficit in attention and appreciation of stimuli on the contralesional side of the body. It has a profound functional impact on affected individuals. A assessment and management of this condition are hindered, however, by the lack of professional awareness and clinical guidelines. Recent evidence suggests that the underlying deficit in visual attention is due to a disrupted internalized representation of the outer world rather than a disorder of sensory inputs. Dysfunction of the cortical domains and white-matter tracts, as well as inter-hemispheric imbalance, have been implicated in the various manifestations of visual neglect. Optimal diagnosis requires careful history-taking from the patient, family, and friends, in addition to clinical assessment with the line bisection test, the star cancellation test, and the Catherine Bergego Scale. Early recognition and prompt rehabilitation employing a multidisciplinary approach is desirable. Although no treatment has been definitively shown to be of benefit, those with promise include prism adaptation, visual scanning therapy, and virtual reality-based techniques. Further high quality research to seek optimum short- and long-term rehabilitative strategies for visual neglect is required.

Neural substrates of visuospatial processing in distinct reference frames: evidence from unilateral spatial neglect

There is evidence for different levels of visuospatial processing with their own frames of reference: viewer-centered, stimulus-centered, and object-centered. The neural locus of these levels can be explored by examining lesion location in subjects with unilateral spatial neglect (USN) manifest in these reference frames. Most studies regarding the neural locus of USN have treated it as a homogenous syndrome, resulting in conflicting results. In order to further explore the neural locus of visuospatial processes differentiated by frame of reference, we presented a battery of tests to 171 subjects within 48 hr after right supratentorial ischemic stroke before possible structural and/or functional reorganization. The battery included MR perfusion weighted imaging (which shows hypoperfused regions that may be dysfunctional), diffusion weighted imaging (which reveals areas of infarct or dense ischemia shortly after stroke onset), and tests designed to disambiguate between various types of neglect. Results were consistent with a dorsal/ventral stream distinction in egocentric/allocentric processing. We provide evidence that portions of the dorsal stream of visual processing, including the right supramarginal gyrus, are involved in spatial encoding in egocentric coordinates, whereas parts of the ventral stream (including the posterior inferior temporal gyrus) are involved in allocentric encoding.