On-line brain potential correlates of right parietal patients' attentional deficit

Hierarchical psychophysiological pathways subtend perceptual asymmetries in Neglect

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

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.

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.

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

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

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

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

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

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

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.

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.

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

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Differential associations of early- and late-night sleep with functional brain states promoting insight to abstract task regularity

Background

Solving a task with insight has been associated with occipital and right-hemisphere activations. The present study tested the hypothesis if sleep-related alterations in functional activation states modulate the probability of insight into a hidden abstract regularity of a task.

Methodology

State-dependent functional activation was measured by beta and alpha electroencephalographic (EEG) activity and spatial synchronization. Task-dependent functional activation was assessed by slow cortical potentials (SPs). EEG parameters during the performance of the Number Reduction Task (NRT) were compared between before sleep and after sleep sessions. In two different groups, the relevant sleep occurred either in the first or in the second half of the night, dominated by slow wave sleep (SWS) or by rapid eye movement (REM) sleep.

Principal Findings

Changes in EEG parameters only occurred in the early-night group, not in the late-night group and indicated occipital and right-hemisphere functional alterations. These changes were associated with off-line consolidation of implicit task representations and with the amount of SWS but they did not predict subsequent insight. The gain of insight was, however, independently associated with changes of spectral beta and alpha measures only in those subjects from the two sleep groups who would subsequently comprehend the hidden regularity of the task. Insight-related enhancement of right frontal asymmetry after sleep did not depend on sleep stages.

Significance

It is concluded that off-line restructuring of implicit information during sleep is accompanied by alterations of functional activation states after sleep. This mechanism is promoted by SWS but not by REM sleep and may contribute to attaining insight after sleep. Original neurophysiologic evidence is provided for alterations of the functional activation brain states after sleep. These alterations are associated with a decrease in controlled processing within the visual system and with an increase in the functional connectivity of the right hemisphere, and are supported by SWS in the first half of the night.

Cortical sources of visual evoked potentials during consciousness of executive processes

What is the timing of cortical activation related to consciousness of visuo-spatial executive functions? Electroencephalographic data (128 channels) were recorded in 13 adults. Cue stimulus briefly appeared on right or left (equal probability) monitor side for a period, inducing about 50% of recognitions. It was then masked and followed (2 s) by a central visual go stimulus. Left (right) mouse button had to be clicked after right (left) cue stimulus. This "inverted" response indexed executive processes. Afterward, subjects said "seen" if they had detected the cue stimulus or "not seen" when it was missed. Sources of event-related potentials (ERPs) were estimated by LORETA software. The inverted responses were about 95% in seen trials and about 60% in not seen trials. Cue stimulus evoked frontal-parietooccipital potentials, having the same peak latencies in the seen and not seen data. Maximal difference in amplitude of the seen and not seen ERPs was detected at about +300-ms post-stimulus (P3). P3 sources were higher in amplitude in the seen than not seen trials in dorsolateral prefrontal, premotor and parietooccipital areas. This was true in dorsolateral prefrontal and premotor cortex even when percentage of the inverted responses and reaction time were paired in the seen and not seen trials. These results suggest that, in normal subjects, the primary consciousness enhances the efficacy of visuo-spatial executive processes and is sub-served by a late (100- to 400-ms post-stimulus) enhancement of the neural synchronization in frontal areas.

ERP and fMRI correlates of endogenous and exogenous focusing of visual-spatial attention

The aim of this study was to investigate the neural correlates of the functional distinction underlying attentional mechanisms of endogenous-sustained and exogenous-transient spatial selection. We recorded event related potentials (ERPs) and used functional magnetic resonance imaging (fMRI) in separate experiments while subjects performed a simple reaction time (RT) to the same visual stimulus displayed to one of several field locations. Endogenous-sustained or exogenous-transient focusing of attention onto target location were obtained by presenting the stimulus in blocks of same-point vs. randomised-point trials, respectively. Same-point stimuli yielded overall faster RT than randomised stimuli, indicating a facilitating effect of endogenous-sustained spatial attention on the perceptual processing of the impending stimulus. Moreover, same-point vs. randomised presentations revealed significant increases in the fMRI signal in the bilateral lingual and fusiform gyri as well as in the right calcarine sulcus, in conjunction with a larger amplitude of the posterior P1 component of ERPs, but no modulation of the amplitude of the N1 component. Rather, a larger amplitude of N1 was found in the reverse contrast, randomised minus same-point trials, which revealed increases in the fMRI signal along the posterior left superior frontal sulcus and bilaterally in the superior precuneus. These findings indicate that N1 indexes exogenous orienting of attention and is likely to represent the activity of frontal and parietal components of the attention network involved in eliciting attention changes. In contrast, the effects of those changes, resulting in a modulation of activation in visual occipital areas, are indexed by P1.

Learning to react: anticipatory mechanisms in children and adults during a visuospatial attention task

OBJECTIVE

To investigate the mechanisms underlying age-related improvement in response times during forewarned motor tasks, using reaction times (RTs) and event-related potentials (ERPs) during a variant of the Posner paradigm.

METHODS

Children and adults reacted to visual targets preceded by a spatial cue.

RESULTS

As expected, adults responded faster than children whatever the cue-target combination, but this advantage could not be explained by differences in attentional orienting to, or detection of, target stimuli. ERP differences between children and adults corresponded almost exclusively to the period preceding target stimuli, where adults, but not children, exhibited a slow negative wave that extended from the delivery of the cue to slightly beyond the presentation of the target.

CONCLUSIONS AND SIGNIFICANCE

The timing, morphology and topography of this slow negativity corresponded to those of 'Contingent Negative Variation' and 'Readiness Potential' processes. We argue that the relative slowness of motor reactions in children during this task was not due to a deficit in spatial orienting or target evaluation, but rather to a failure in developing anticipatory and preparatory reactions in response to cues, i.e. a deficit in executive functions.

Visuo-spatial Consciousness and Parieto-occipital Areas: A High-resolution EEG Study

Conscious and unconscious visuo-spatial processes are mainly related to parieto-occipital cortical activation. In this study, the working hypothesis was that a specific pattern of parieto-occipital activation is induced by conscious, as opposed to unconscious, visuo-spatial processes. Electroencephalographic data (128 channels) were recorded in 12 normal adults during a visuo-spatial task. A cue stimulus appeared on the right or the left (equal probability) monitor side for a 'threshold time' inducing approximately 50% of correct recognitions. It was followed (after 2 s) by visual go stimuli at spatially congruent or incongruent positions with reference to the cue location. The left (right) mouse button was clicked if the go stimulus appeared on the left (right) monitor side. Subjects were required to say 'seen' if they had detected the cue stimulus or 'not seen' if they missed it (self-report). 'Seen' and 'not seen' electroencephalographic trials were averaged separately to form visual evoked potentials. Sources of these potentials were estimated by LORETA software. Reaction time to go stimuli was shorter during spatially congruent than incongruent 'seen' trials, possibly due to covert attention on cue for self-report. It was also shorter during spatially congruent than incongruent 'not seen' trials, as an objective sign of unconscious processes. Cue stimulus evoked parieto-occipital potentials which has the same peak latencies in the 'seen' and 'not seen' cases. Sources of these potentials were located in occipital area 19 and parietal area 7. Source strength was significantly stronger in 'seen' than 'not seen' cases at approximately +300 ms post-stimulus. These results may unveil features of parieto-occipital activation accompanying visuo-spatial consciousness.

Event-related potential measures of consciousness: two equations with three unknowns

This is a brief review of event-related brain potentials (ERPs) as indices of cortical information processing in conditions in which conscious perception of stimuli is supposed to be absent: sleep, coma, vegetative state, general anesthesia, neglect as well as presentation of subliminal or masked stimuli. Exogenous ERP components such as N1 and P2 are much more likely to remain in all these conditions than endogenous components. Further, all varieties of the late posterior positive ERP waves (e.g., P3b, P600, late positive complex) are most difficult to be elicited in such conditions, indicating that the cortical activity underlying the late posterior positivity may have a particularly close relationship to brain mechanisms of conscious perception. Contrary to what might be expected, reliable ERP effects indicating complex analysis of semantic stimulus features (i.e., meaning) can be recorded without conscious awareness, generally, as easy as (in some conditions, even easier than) ERP components related to rather simple physical stimulus features. It should be emphasized, however, that we never should overestimate our confidence about the degree of subjects' unawareness. Particularly in the conditions in which no behavioral response can be obtained (e.g., sleep, coma, anesthesia), residual conscious processing, at least in some subjects and on some trials, cannot be ruled out.

Effects of same- and different-modality cues in a Posner task: extinction-type, spatial, and non-spatial deficits after right-hemispheric stroke

The response delay to left target stimuli preceded by right-side cues, first described by Posner et al. [J. Neurosci. 4 (1984) 1863-1874] appears to be a stable marker of right-parietal injury. However, only few studies compared patients' performance to age-matched controls. Furthermore, only few studies compared visual and auditory stimuli in this task. Therefore, two groups of right-hemisphere stroke patients, with and without left visual hemineglect, and a healthy control group were studied in three versions of Posner's paradigm. Visual or auditory target stimuli were presented to the subject's left or right, following a visual or auditory cue by 150 ms. The classical 'extinction-type' effect, an increase in missing responses for right visual cue/left visual target, was specifically observed in neglect patients. In the same condition, an 'extinction-type' response delay was present in patients with neglect and in those without neglect. No such delay occurred in any group when cues were auditory. Specifically in neglect patients, response times were generally longer for left than for right visual targets, regardless of cue side and of cue modality. Response times were generally prolonged in neglect patients regardless of target modality. This suggests that three components impair neglect patients' performance in this paradigm: a non-spatial, supramodal deficit, a global, neglect-type deficit of the contralesional hemi-field, and the extinction-type impairment. The latter two deficits appear to be most marked within the visual domain.

Pre-requisites for conscious awareness: clues from electrophysiological and behavioral studies of unilateral neglect patients

Encoding sensory events entails processing of several physical attributes. Is the processing of any of these attributes a pre-requisite of conscious awareness? This selective review examines a recent set of behavioral and event-related potentials, studies conducted in patients with visual and auditory unilateral neglect or extinction, with the aim of establishing what aspects of initial processing are impaired in these patients. These studies suggest that extinguished visual stimuli excite the sensory cortices, but perhaps to a lesser degree than acknowledged stimuli do. However, encoding spatial attributes of auditory and visual stimuli appear to be preferentially impaired. In light of results from patients with other neuro-behavioral deficits, it is argued that egocentric spatial information is an essential pre-requisite for knowing that an external event occurred. In contrast, information handled by mostly domain-specific circuits, such as in the ventral temporal lobe, supports awareness of the identity of a stimulus, but not of its mere presence. Without spatial information, the stimulus identity will remain implicit.

What exactly is extinguished in unilateral visual extinction? Neurophysiological evidence

We propose a model of unilateral visual extinction following right hemisphere lesions based on competition between contralesional and ipsilesional input to access a decision centre located in the left hemisphere. During bilateral presentations, the contralesional signal is on average less likely to activate the decision centre than the ipsilesional signal. This is because an intra-hemispheric lack of top-down attentional influences and an inter-hemispheric impairment of callosal transmission delay and/or weaken the contralesional input. Here we provide behavioural as well as event-related potential evidence for both these impairments. Finally, we argue that an essential prerequisite for contralesional extinction is the presence of a restricted general attentional capacity which often follows large right hemisphere damage.

Attention shifts and anticipatory mechanisms in hyperactive children: an ERP study using the Posner paradigm

BACKGROUND

The aim of this study was to assess attentional, decisional, and motor processing stages during the performance of an attention shifting paradigm, both in normal children and children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We recorded event-related potentials (ERPs) and performance measures during a variant of the Posner paradigm in 13 control subjects and 24 ADHD children. Subjects responded with a spatially concordant motor response to left or right visual targets, which could be either preceded by a spatial cue ("valid" = same side; "invalid" = opposite side) or presented uncued.

RESULTS

Patients made significantly more errors than control subjects, with predominance of the anticipatory type. As compared to control subjects, ADHD children had faster reaction times, as well as a shortened interval between the N2 and P3 ERPs and the motor response. Patients also showed a decreased attentional priming effect on early sensory responses (P1). Finally, the slow negativity (contingent negative variation/readiness potential) that preceded the target in the "no cue" condition was absent in ADHD patients.

CONCLUSIONS

The combined analysis of electrophysiological and behavioral data suggest a characteristic mode of response of ADHD in attention shifting tasks, characterized by "motor impulsivity" with release of motor responses before stimulus processing is adequately completed, as well as a lack of strategic planning/anticipatory mechanisms in the absence of warning stimulus. These deficits may be partly attributed to dysmaturation of executive frontal functions. In addition, a minor deficit in early attentional priming was also observed in ERPs, with no apparent behavioral counterparts.

Functional Magnetic Resonance Imaging and Evoked Potential Correlates of Conscious and Unconscious Vision in Parietal Extinction Patients

We describe recent functional magnetic resonance imaging (fMRI) and event-related potential (ERP) studies of visual extinction in patients with right parietal damage who can detect isolated visual stimuli on either side, yet often miss contralesional (left) stimuli during bilateral stimulation. We consider the neural fate of such extinguished visual stimuli and how neural responses differ for consciously detected versus extinguished stimuli. fMRI findings indicate that extinguished stimuli evoke activity in striate and ventral extrastriate visual cortex, despite escaping awareness. Activations for extinguished stimuli can be found even in category-specific (face-responsive) areas of the fusiform gyrus. On the other hand, activations in visual cortex are stronger for consciously detected versus extinguished stimuli, with parietal and frontal areas of the intact left hemisphere also implicated in this comparison. Recent ERP data likewise suggest differential neural responses for consciously detected versus extinguished stimuli. We discuss these findings in relation to current speculations about the neural basis of conscious and unconscious perception.

Electrophysiological evidence for an early(pre-attentive) information processing deficit in patients with right hemisphere damage and unilateral neglect

Patients with right hemisphere damage and contralesional neglect are often unaware of visual, auditory or tactile stimuli occurring on their left side. In an effort to understand the contribution of pre-attentive processes to this phenomenon, we examined the processing of the pitch, duration and spatial location of auditory stimuli using an electrophysiological probe, the mismatch negativity (MMN). This event-related brain potential indexes the integrity of cerebral processes that respond automatically to deviations from regularity in the acoustic environment. We compared the MMN elicited by right- and left-sided deviant stimuli in 10 patients with left unilateral neglect and 10 age-matched healthy volunteers, exploring an anticipated dissociation between the processing of spatial localization of sounds and the processing of the other auditory dimensions. Across dimensions, the MMN elicited by deviance occurring to the left of the patients was reduced relative to that elicited by deviance occurring to the right. This effect was robust for spatial location, and less so for pitch, whereas the processing of stimulus duration was not significantly affected by the side of stimulation. In healthy subjects, deviance in either side elicited similar MMN. We suggest that an early deficit in detecting changes in the environment hampers the involuntary triggering of attention in those patients and discuss the specific role of encoding spatial location in the establishment of conscious awareness.

Amplitudes and latencies of single-trial ERP's estimated by a maximum-likelihood method

The common approach in research on event-related electroencephalogram (EEG) potentials is to assume that the trigger-related signal is always the same and can be extracted from EEG background activity by simple averaging. To check the validity of this approach and to provide more exact results, latencies and amplitudes of components have to be estimated in single trials. Pham et al. applied a maximum-likelihood approach to solve the more general model which assumes that the signal hidden in EEG background activity has the same shape and amplitude but may vary in its latency from trial to trial. Extending their method we present a solution in which amplitude variability is also allowed. The utility of the solution to estimate the P3 component in single trials was investigated both by extensive pseudoreal simulations and in an application to real data. The simulations showed some advantage of the method over two other methods (Woody's method and peak-picking) commonly used in event-related potentials research. Application to real data provided a plausible description of single-trial sequential effects on the amplitude of the P3 component.