Applying a precisely timed pulse of transcranial magnetic stimulation (TMS) over the right posterior parietal cortex (PPC) can produce temporary visuo-spatial neglect-like effects. Although the TMS is applied over PPC, it is not clear what other brain regions are involved. We applied TMS within a functional magnetic resonance imaging (fMRI) scanner to investigate brain activity during TMS induction of neglect-like bias in three healthy volunteers, while they performed a line bisection judgment task (i.e., the landmark task). Single-pulse TMS at 115% of motor threshold was applied 150 ms after the visual stimulus onset. Participants completed two different TMS/fMRI sessions while performing this task: one session while single-pulse TMS was intermittently and time-locked applied to the right PPC and a control session with TMS positioned over the vertex. Perceptual rightward bias was observed when TMS was delivered over the right PPC. During neglect-like behavior, the fMRI maps showed decreased neural activity within parieto-frontal areas, which are often lesioned or dysfunctional in patients with left neglect. Vertex TMS induced behavioral effects compatible with leftward response bias and increased BOLD signal in the left caudate (a site which has been linked to response bias). These results are discussed in relation to recent findings on neural networks subserving attention in space.

Introduction: Unilateral spatial neglect (USN) is a disorder of contralesional space awareness which often follows unilateral brain lesion. Since USN impairs awareness of contralesional space/body and often of concomitant motor disorders, its presence represents a negative prognostic factor of functional recovery. Thus, the disorder needs to be carefully diagnosed and treated. Here, we attempted to present a clear and concise picture of current insights in the comprehension and rehabilitation of USN. Methods: We first provided an updated overview of USN clinical and neuroanatomical features and then highlighted recent progresses in the diagnosis and rehabilitation of the disease. In relation to USN rehabilitation, we conducted a MEDLINE literature research on three of the most promising interventions for USN rehabilitation: prismatic adaptation (PA), non-invasive brain stimulation (NIBS), and virtual reality (VR). The identified studies were classified according to the strength of their methods. Results: The last years have witnessed a relative decrement of interest in the study of neuropsychological disorders of spatial awareness in USN, but a relative increase in the study of potential interventions for its rehabilitation. Although optimal protocols still need to be defined, high-quality studies have demonstrated the efficacy of PA, TMS and tDCS interventions for the treatment of USN. In addition, preliminary investigations are suggesting the potentials of GVS and VR approaches for USN rehabilitation. Conclusion: Advancing neuropsychological and neuroscience tools to investigate USN pathophysiology is a necessary step to identify effective rehabilitation treatments and to foster our understanding of neurofunctional bases of spatial cognition in the healthy brain.

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A series of studies have consistently reproduced left neglect-like bias on line length estimation tasks in healthy participants by applying transcranial magnetic stimulation (TMS) over the right posterior parietal cortex (PPC), while no significant changes have been reported when stimulating the left PPC. However, a notable inter-individual variability in the right parietal site where TMS modulates visuospatial perception can be observed, and no general agreement exists on how to identify the optimal parietal site of stimulation. In the present study, we propose a new site-finding TMS protocol to easily identify the optimum parietal location, or “hot spot,” where TMS may modulate visuospatial perception on a line length estimation task (the Landmark task). Single-pulse TMS at 115% of motor threshold was applied 150 ms after the visual stimulus onset over nine different sites of a 3 cm × 3 cm grid, centred over right or left PPC (P4 and P3 according to the 10–20 EEG system, respectively) in eight healthy participants. Stimulation of right PPC induced a significant left neglect-like bias, when the coil was applied over the most posterior and dorso-posterior sites. Unexpectedly, TMS over left PPC also produced left neglect-like bias. However, in this case significant effects were found when targeting the most anterior and dorso-anterior portions of the grid. These results are discussed in relation to recent findings on neural networks underlying spatial cognition. The hunting protocol we propose might offer an economical and easy-to-use tool to functionally identify the optimal parietal site where TMS can modulate visuospatial perception, in healthy subjects and possibly in post-stroke patients undergoing repetitive transcranial magnetic stimulation treatment.