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Sir,We would like to make a few comments on the interesting paper recently published in Brain by Karnath et al. (2011). We were impressed by the careful assessment of spatial neglect during acute and chronic phase, which was combined with a solid voxel-wise lesion symptom mapping technique in a series of 54 patients with right-hemisphere stroke. Anatomical data indicated that lesions in the superior and middle temporal gyri, the basal ganglia, as well as the inferior occipitofrontal fasciculus are responsible for spatial neglect in both acute and chronic phases.We also had the opportunity to evaluate 69 patients with right brain lesions longitudinally. Our patients were admitted after a first right-hemisphere stroke (mean delay: 7.5 AE 14.6 days), at a mean age of 64.95 AE 14.6 years. Mean delay between the acute and chronic phase was 350.21 AE 184.7 days. These demographic data are comparable with the patients of Karnath et al. (2011). Neglect was considered as present when patients failed at least two out of eight tests (Table 1)-unlike diagnoses based on two out three tests in Karnath et al. (2011). In the acute phase, 31 patients had neglect (45%). In the chronic phase, 17 of these 31 neglect patients still showed a significant impairment (55%). Using the same voxel-wise lesion mapping as Karnath et al. (2011), we found partly different results, particularly in the acute phase (detailed below). However, we believe that major differences in the findings may depend on the clinical measures used to define neglect, since this syndrome may include heterogeneous symptoms.

Recent findings indicate that synchronous neural activity at rest influences human performance in subsequent tasks. Synchronization can occur in form of phase coupling or amplitude correlation. It is unknown whether these coupling types have differing behavioral significance at rest. To address this, we performed resting-state electroencephalography (EEG) and source connectivity analysis in several populations of healthy subjects and patients with brain lesions. We systematically compared different types and frequencies of neural synchronization and investigated their association with behavioral performance in verbal and spatial attention tasks. Behavioral performance could be consistently predicted by two distinct resting-state coupling patterns: (1) amplitude envelope correlation of beta activity between homologous areas of both hemispheres, (2) lagged phase synchronization in EEG alpha activity between a brain area and the entire cortex. A disruption of these coupling patterns was also associated with neurological deficits in patients with stroke lesions. This suggests the existence of two distinct network systems responsible for resting-state integration. Lagged phase synchronization in the alpha band is associated with global interaction across networks while amplitude envelope correlation seems to be behaviorally relevant for interactions within networks and between hemispheres. These two coupling types may therefore provide complementary insights on brain physiology and pathology.