Spatial attention systems in spatial neglect

It has been established that processes relating to 'spatial attention' are implemented at cortical level by goal-directed (top-down) and stimulus-driven (bottom-up) networks. Spatial neglect in brain-damaged individuals has been interpreted as a distinguished exemplar for a disturbance of these processes. The present paper elaborates this assumption. Functioning of the two attentional networks seem to dissociate in spatial neglect; behavioral studies of patients' orienting and exploration behavior point to a disturbed stimulus-driven but preserved goal-directed attention system. When a target suddenly appears somewhere in space, neglect patients demonstrate disturbed detection and orienting if it is located in contralesional direction. In contrast, if neglect patients explore a scene with voluntarily, top-down controlled shifts of spatial attention, they perform movements that are oriented into all spatial directions without any direction-specific disturbances. The paper thus argues that not the top-down control of spatial attention itself, rather a body-related matrix on top of which this process is executed, seems affected. In that sense, the traditional role of spatial neglect as a stroke model for 'spatial attention' requires adjustment. Beyond its insights into the human stimulus-driven attentional system, the disorder most notably provides vistas in how our brain encodes topographical information and organizes spatially oriented action - including the top-down control of spatial attention - in relation to body position.