Partial recovery of visual extinction by pavlovian conditioning in a patient with hemispatial neglect

Patients with parietal lesions and unilateral spatial neglect (USN) are unable to detect or respond to information in the contralesional side of space. However, some residual sensory processing may still occur and overcome inattention symptoms when contralesional stimuli are perceptually or biologically salient, as shown for emotional faces or voices. These effects have been attributed to enhanced neural responses of sensory regions to emotional stimuli, presumably driven by feedback signals from limbic regions such as the amygdala. However, because emotional faces and voices also differ from neutral stimuli in terms of physical features, the affective nature of these effects still remains to be confirmed. Here we report data from a right parietal patient in whom left visual extinction was reduced for contralesional visual stimuli following pavlovian aversive conditioning, relative to the same stimulus before conditioning, and relative to similar but non-conditioned stimuli. This reduction of visual extinction was thus mediated by the emotional meaning of stimuli acquired through implicit learning. Functional magnetic resonance imaging also showed that conditioned visual stimuli elicited greater activation in right visual cortex, relative to the non-conditioned stimuli, together with differential activations in amygdala. These results support the hypothesis that emotional appraisal, not only the processing of perceptual features, may partly restore attention to salient information in contralesional space. These findings open new perspectives to improve rehabilitation strategies in neglect, based on affective and motivational signals.