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Neurology 1999;52:571
© 1999 American Academy of Neurology
Articles

Somatosensory cortical activations are suppressed in patients with tactile extinction

A PET study

P. Remy, MD, PhD, M. Zilbovicius, MD, PhD, J.-D. Degos, MD, A.-C. Bachoud-Lévi, MD, G. Rancurel, MD, P. Cesaro, MD, PhD and Y. Samson, MD

From Commissariat à l’Energie Atomique (Drs. Remy, Zilbovicius, and Samson), Service Hospitalier Frédéric Joliot, Orsay; Service de Neurologie (Drs. Remy, Degos, Bachoud-Lévi, and Cesaro), Centre Hospitalo-Universitaire Henri-Mondor, Créteil; and Urgences Cérébro-Vasculaires (Drs. Rancurel and Samson), Centre Hospitalo-Universitaire Pitié-Salpêtrière, Paris, France.

Address correspondence and reprint requests to Dr. Philippe Remy, CEA, Service Hospitalier Frédéric Joliot, 4, Place du Général Leclerc, 91401 Orsay Cedex, France.

OBJECTIVE: To investigate whether tactile extinction alters the cortical somatosensory activations induced by hand vibration.

BACKGROUND: Tactile extinction occurs mainly after right-brain lesions and consists of the inability to perceive a contralesional cutaneous stimulation when a similar stimulus is applied to the mirror region of the ipsilesional hemibody. The pathophysiology of tactile extinction is poorly understood, but it is considered to be a deficit of selective attention of somatosensory stimuli. Although other theories have been proposed, our understanding of the pathophysiology of tactile extinction may benefit from functional imaging studies.

METHODS: We selected three patients with pure tactile extinction and a mainly subcortical right-brain lesion that spared the primary sensorimotor cortex (SM1). We used PET to investigate the responses to unilateral and bilateral hand vibration in SM1 and the secondary somatosensory cortical area (SII).

RESULTS: During bilateral hand vibration, activation was normal in the left SM1, suppressed in the right SM1, and markedly decreased in both SII, which was consistent with the extinction of the left-hand stimulus. During unilateral left-hand vibration, the activation of the right SM1 was still markedly impaired, but the activation of both SII was normal.

CONCLUSIONS: We found marked changes in the activation of cortical somatosensory areas induced by hand vibration in patients with tactile extinction. The role of selective attention in cortical activation is also examined.




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