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Evoking visual neglect-like deficits in healthy volunteers – an investigation by repetitive navigated transcranial magnetic stimulation

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ABSTRACT

In clinical practice, repetitive navigated transcranial magnetic stimulation (rTMS) is of particular interest for non-invasive mapping of cortical language areas. Yet, rTMS studies try to detect further cortical functions. Damage to the underlying network of visuospatial attention function can result in visual neglect—a severe neurological deficit and influencing factor for a significantly reduced functional outcome. This investigation aims to evaluate the use of rTMS for evoking visual neglect in healthy volunteers and the potential of specifically locating cortical areas that can be assigned for the function of visuospatial attention. Ten healthy, right-handed subjects underwent rTMS visual neglect mapping. Repetitive trains of 5 Hz and 10 pulses were applied to 52 pre-defined cortical spots on each hemisphere; each cortical spot was stimulated 10 times. Visuospatial attention was tested time-locked to rTMS pulses by a landmark task. Task pictures were displayed tachistoscopically for 50 ms. The subjects’ performance was analyzed by video, and errors were referenced to cortical spots. We observed visual neglect-like deficits during the stimulation of both hemispheres. Errors were categorized into leftward, rightward, and no response errors. Rightward errors occurred significantly more often during stimulation of the right hemisphere than during stimulation of the left hemisphere (mean rightward error rate (ER) 1.6 ± 1.3 % vs. 1.0 ± 1.0 %, p = 0.0141). Within the left hemisphere, we observed predominantly leftward errors rather than rightward errors (mean leftward ER 2.0 ± 1.3 % vs. rightward ER 1.0 ± 1.0 %; p = 0.0005). Visual neglect can be elicited non-invasively by rTMS, and cortical areas eloquent for visuospatial attention can be detected. Yet, the correlation of this approach with clinical findings has to be shown in upcoming steps.

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Abbreviations

dti:

Diffusion tensor imaging

er:

Error rate

fef:

Frontal eye field

fmri:

Functional magnetic resonance imaging

ft:

Fiber tracking

ipi:

Inter-picture-interval

mri:

Magnetic resonance imaging

rmt:

Resting motor threshold

ntms:

Navigated transcranial magnetic stimulation

rtms:

Repetitive navigated transcranial magnetic stimulation

tms:

Transcranial magnetic stimulation

tpj:

Temporoparietal junction

sd:

Standard deviation

vas:

Visual analogue scale

3-d:

Three-dimensional

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Acknowledgments

The first author gratefully acknowledges the support of the TUM graduate school.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Katrin Giglhuber, Stefanie Maurer, Bernhard Meyer & Sandro M. Krieg

  2. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Katrin Giglhuber, Stefanie Maurer & Sandro M. Krieg

  3. Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Claus Zimmer

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  1. Katrin Giglhuber
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  5. Sandro M. Krieg
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Correspondence to Sandro M. Krieg.

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Conflict of interest

SK is a consultant for BrainLab AG (Feldkirchen, Germany). Yet, the study was completely financed by institutional grants from the Department of Neurosurgery and the Section of Neuroradiology, and all authors declare to have no conflict of interest affecting this study, nor the materials or methods used, nor the findings specified in this paper.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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Giglhuber, K., Maurer, S., Zimmer, C. et al. Evoking visual neglect-like deficits in healthy volunteers – an investigation by repetitive navigated transcranial magnetic stimulation. Brain Imaging and Behavior 11, 17–29 (2017). https://doi.org/10.1007/s11682-016-9506-9

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