Louis Gudmundsson 1,2, Jakub Vohryzek1, Eleonora Fornari3, Stephanie Clarke2, Patric Hagmann1, and Sonia Crottaz-Herbette2
1Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, 1011 Lausanne, Switzerland, Unil, Lausanne, Switzerland, 2Neuropsychology and Neurorehabilitation Service, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, 1011 Lausanne, Switzerland, Unil, Lausanne, Switzerland, 3CIBM (Centre d'Imagerie Biomédicale), Dept. of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, 1011 Lausanne, Switzerland, Unil, Lausanne, Switzerland
Synopsis
Prismatic adaptation (PA), a therapy for
neglect after a stroke, showed conflicting results in the literature. The variability
of brain lesions leading to neglect and their relation to structures affected
by PA could explain those results. MRI studies found focal brain activations after
PA. We aim to understand if there is an effect on functional networks after PA.
To do so, we analyzed the resting state fMRI connectivity of healthy subjects
before and after PA. We found that the ventral attention system (VAS) was less
connected after PA, this provides new insights to select patients for this therapy.
Introduction and purpose
Prismatic adaptation (PA) consists of a
brief session during which subjects point to targets under visual control while
wearing goggles with prisms that deviate the visual field1. Such adaptation is used in the rehabilitation of spatial neglect,
a common disorder following right hemispheric damage, characterized by
disturbances of spatial representation and attention, with a tendency to ignore
stimuli in the left visual field2.
In control subjects, task-related fMRI have
shown that PA modulates principally the activity of the inferior parietal
lobule (IPL)3,4 suggesting that PA changes the right hemispheric dominance within
the Ventral Attention System (VAS) by shifting the visual field representation
from right to left IPL hemisphere3. Here, we tested this hypothesis by using resting-state fMRI
acquisition before and after a PA session and investigated PA-related
modulations of the VAS, the Dorsal Attention System (DAS) and the Default Mode
Network (DMN). Method
We obtained on 26 subjects 10 minutes of
resting state functional MRI data before and after an adaptation (3T Siemens Magnetom
Trio scanner with a 32-channel head-coil, TR=2sec, 32 slices, 3mm isotropic).
During the adaptation 14 subjects wore rightward deviating prisms (treated
group), 12 other subjects wore plain glasses (control group). Graph metrics on
resting state connectivity matrices were calculated using Matlab and the brain
connectivity toolbox5.
We worked with a brain parcellation of 83
regions of interest (ROIs)6 and focused on three networks, the VAS, DAS and DMN (Fig. 1). After
a consultation with an expert, we selected the ROIs of the aforementioned
networks based on the Yeo 7 functional systems parcellation7. For each network separately, the mean correlation coefficient of
connections between nodes of the network, called total connectivity5, was calculated. The differences ‘before-after adaptation’ were
compared between groups using bilateral independent-samples t-tests in SPSS. Results
The total connectivity was lower after
compared to before adaptation for the DMN, VAS in the prisms group and for the
DAS in both groups, whereas it was higher after compared to before adaptation
only for the control group in the DMN and VAS (Fig. 2). However, the difference between groups was
significant only for the VAS network (t(24)=2.49;p=0.02), not for the DMN
(t(24)=1.90;p=0.69) nor the DAS (t(24)=0.75;p=0.461).Discussion and conclusion
Our results provide new evidence for a
modulation of the attentional systems by rightward PA. More precisely, PA
changes significantly the functional connectivity in the VAS, and neither in
the DAS nor in the DMN. The VAS, including the temporo-parietal junction and
the ventral frontal cortex, responds typically to behaviorally relevant stimuli
occurring unexpectedly, as opposed to the DAS that includes the intraparietal sulcus and frontal eye fields and underlies
active orientation of attention8.
Our findings confirm that, as proposed in
the SHD-VAS model9, PA modulates the ventral attentional regions. Taken together with
previous findings showing an increased activation in the left IPL after PA, our
current results suggest that PA uncover spatial representation of ventral
regions of the left hemisphere by changing the connectivity in the VAS. Our
results provide new insights to optimize the choice of PA for the
rehabilitation of spatial neglect for patients having a spared VAS. Acknowledgements
No acknowledgement found.References
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