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Functional anatomy of the therapeutic effects of prism adaptation on left neglect

From the INSERM (J.L., G.R., L.P., S.J.C., D.B., Y.R.), U534, Espace et Action, Bron, France; Hospices Civils de Lyon (J.L., G.R., S.J.C., D.B., Y.R.), Hôpital Henry Gabrielle, Service de Rééeducation Neurologique, Mouvement et Handicap, Saint Genis Laval, France; Université Claude Bernard Lyon I (J.L., G.R., L.P., S.J.C., F.C., D.B., Y.R.), Faculté de Médecine, Institut Fédératif des Neurosciences de Lyon, IFR19, Lyon, France; INSERM (C.M.), ERIT-M 0207, Motricité-Plasticité: Performance, Dysfonctionnement, Vieillissement et Technologies d’optimisation, Dijon, France; Hospices Civils de Lyon (F.C.), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite, France; CERMEP (N.C., D.L.B.), Hôpital Neurologique, Bron, France; INSA-502 (F.C.), CREATIS, Villeurbanne, France; and School of Psychology (P.H.), Cardiff University, Cardiff, UK.

Address correspondence and reprint requests to Pr. Yves Rossetti, INSERM Unité 534, Espace et Action, 16, Avenue du doyen Lépine, 69500 Bron, France; e-mail: rossetti{at}lyon.inserm.fr

Objective: To investigate the anatomic substrates underlying the beneficial effect of prism adaptation in five patients with persistent left neglect following right stroke.

Methods: In a functional imaging PET study, we used a covariation analysis to examine linear changes of regional cerebral blood flow over sessions as a function of left neglect improvement.

Results: The network of significant brain regions associated with improvement of left neglect performance produced by prism adaptation involved the right cerebellum, the left thalamus, the left temporo-occipital cortex, the left medial temporal cortex, and the right posterior parietal cortex.

Conclusion: Our results suggest that the realignment of visuomotor coordinates is processed by the cerebellum and that low level sensorimotor adaptation actively modulates cerebral areas, albeit now relying on intact cerebellocerebral connections. Hence, our data support the hypothesis that the beneficial effect of prism adaptation on the clinical presentation of left neglect derives from modulation of cortical regions implicated in spatial cognition.

*Authors contributed equally to the final paper.

This work was supported in part by INSERM PROGRES (no. 4P012E); ACI Neuroscience (Plasticité), Programme Hospitalier de Recherche Clinique National (PHRC no. 30251).

Disclosure: The authors report no conflicts of interest.

Received August 4, 2005. Accepted in final form March 7, 2006.

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