The electrophysiology of tactile extinction: ERP correlates of unconscious somatosensory processing

We examined the electrophysiological correlates of left-sided tactile extinction in a patient with right-hemisphere damage. Computer-controlled punctate touch was presented to the left, right or both index fingers in an unpredictable sequence. The patient reported his conscious tactile percept ("left", "right" or "both"). He showed extinction on 75% of bilateral trials, reporting only right stimulation for these. Somatosensory evoked potentials for unilateral stimulation showed early components over contralateral somatosensory areas (P60 and N110) for either hand. In contrast to the results observed for age-matched controls, the patient's P60 was smaller in amplitude for left-hand touch over the right hemisphere than for right-hand touch over the intact hemisphere. Bilateral trials with extinction revealed residual P60 and N110 components over the right hemisphere in response to the extinguished left touch. These results demonstrate residual unconscious somatosensory processing of extinguished touch. They also suggest that tactile extinction can be caused by attenuation rather than elimination of somatosensory responses in the damaged hemisphere, with an underlying deficit even on unilateral trials.