Using non-invasive brain interference as a tool for mimicking spatial neglect in healthy volunteers

Visuospatial processing refers to the spatial perception, recognition and analysis of visual input. Human functional brain imaging studies have consistently revealed the involvement of fronto-parietal brain areas during the execution of visuospatial tasks. Just as the execution of these tasks activates fronto-parietal regions in the healthy brain, lesions to those structures, e.g. after stroke or brain injury, cause specific spatial deficits. The most prominent of these is known as spatial neglect. There are several competing theories on the neural mechanisms underlying spatial neglect. Although each of these theories postulates different underlying physiological mechanisms, they all account in their own way for the fact that the prevalence of neglect is much higher following right hemisphere lesions. This makes it difficult to distinguish between the different models at a behavioural level. Until today, it was impossible to empirically address these matters and to provide direct and conclusive empirical evidence in favour of one of the competing theories of spatial neglect. This review article describes the neural correlates of intact visuospatial processing as revealed by non-invasive functional brain imaging studies. It subsequently focuses on the approach of using the non-invasive brain inference technique of transcranial magnetic brain stimulation (TMS) to transiently and reversibly disrupt neural activity in these visuospatial processing-related brain regions. Using this approach, we can now imitate specific spatial deficits and neglect-like symptoms in healthy volunteers. Mimicking and manipulating the spatial deficits following unilateral brain lesions, under controlled experimental conditions, may allow for the development of new therapeutic interventions for parietal stroke patients suffering from real spatial neglect. The perspective is to use non-invasive brain interference to guide and promote functional recovery on a brain-system level in stroke and neglect patients, based on knowledge directly derived from fundamental brain research in healthy volunteers.