Visual spatial neglect in multiple sclerosis

Neuropsychological dysfunction in multiple sclerosis (MS) patients is now a well-established clinical finding. We examined the entity of visual spatial neglect in demyelinating disease and its correlation to the functional and neuroradiological parameters. The phenomenon of visual spatial neglect was examined in 20 (5 male and 15 female) MS patients. Two different examination methods were used--the line bisection test and the random shape cancellation test. The results were compared with 20 aged matched control individuals. The correlation of the visual spatial neglects to neurological deficits and handicaps, using Kurtzke's Expanded Disability Status Scale (EDSS), as well as with the MRI's neuroradiological findings, was analyzed. A highly significant different result on the line bisection test for three various line lengths (p = .006, p < .0001, p < .001) with displacement towards the right side was found. In all the cancellation subtests, a significant difference in error rate was found in comparing patients to controls toward a higher one on the left side of the MS patients (p = .005, p < .002, p < .0001 and p = .02 in the left side subtest, and p = n.s. in the right side subtest). There was no significant correlation between the cancellation tests and bisection results and the EDSS scale data, as well as with the neuroradiological findings. The present results demonstrate the presence of visual spatial neglect among MS patients, even without the demonstration of a characteristic neuroanatomical lesion. The hypotheses for this finding are discussed with a stress on the possibility of disruption of multiple intrahemispheric connections, especially under the condition of asymmetry of dominance regarding spatial attention.