Deficient processing of regularity violations during visuospatial neglect: a visual mismatch negativity study

Visuospatial neglect (VSN) after right-hemisphere stroke causes reduced engagement with left-sided stimuli, but how VSN affects automatic processes, i.e. the registration of regularities and regularity violations is still equivocal. This study investigated these processes using event-related potential components C1, C2/N1, and the visual mismatch negativity (vMMN), and how they differ in VSN compared to stroke and healthy controls, and their changes with time and rehabilitation. We applied a passive oddball paradigm, where diamond patterns periodically disappeared (OFF events) and reappeared (ON events) on the lower left and right sides, creating two simultaneous but independent sequences with standard and deviant events. The study included a VSN group (N = 17, M = 53.88 ± 0.28 yrs); stroke patients (N = 16, M = 56.81 ± 13.26 yrs); and healthy participants (N = 17, M = 53.89 ± 10.79 yrs). The VSN group underwent measurements three times: pre- and post-rehabilitation, and at a 4-month follow-up. Our results show that the C1 component emerged reliably in healthy participants and as a tendency in stroke controls, but not in VSN at any measurement point. The C2/N1 component emerged for all events without group differences. VSN patients showed no reliable vMMN, while it emerged in stroke patients for left-sided OFF events. Healthy controls showed vMMN in every condition. Our results suggest that both stroke and VSN impair the automatic detection of regularity violations, but VSN does so in a more substantial way, and this deficit does not improve with time or rehabilitation. Furthermore, the missing C1 component in VSN may indicate an early-stage deficiency even in visual processing.