Neglect and extinction in kinesthesia and thesesthesia: understanding proprioceptive inattention.
This paper describes a new observation of neglect and extinction of kinesthesia and thesesthesia (movement and position imperception), jointly reflecting proprioceptive inattention, in a series of patients with parietal lesions. A prototypical case is discussed in detail and unaddressed aspects of proprioceptive inattention are discussed through findings from four additional cases. Thesesthetic and kinesthetic extinction were tested through simultaneous antidromic vertical displacement of index fingers, while having patients report on finger proprioceptive perception with eyes closed. Patients had variable degrees of proprioceptive inattention affecting a specific limb, but without pallesthetic inattention or somatoagnosia, whereas symptoms often resolved with visual feedback or active limb movements. Findings support that kinesthesia and thesesthesia (a) are subserved by near-identical brain networks, (b) relate more to tactile perception than pallesthesia in higher order cortical areas, and (c) have a somatotopic cortical organization even in association brain areas. Furthermore, proprioceptive extinction and neglect involve (i) "attention network" structures, (ii) either hemisphere, (iii) gray or subcortical white matter damage, (iv) defective vigilance mechanisms possibly through premature habituation of spatiotemporally saturated neural capacitor circuits, and (v) are not the result of somatoagnosia, while (vi) their resolution is observed through reafferent motor-sensory or visual feedback.
a Memory and Aging Center, Department of Neurology , University of California San Francisco , San Francisco , CA , 94158 , USA.|b Department of Neurology , University of Minnesota , Minneapolis , MN , 55455 , USA.|c Neurological Institute of Athens , Athens , 10676 , Greece.
Elissaios
E
Karageorgiou
D001288:Attention / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D007699:Kinesthesis / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010296:Parietal Lobe / Q000473:pathology*; D010468:Perceptual Disorders / Q000150:complications* / Q000473:pathology; D010812:Physical Stimulation; D020886:Somatosensory Disorders / Q000150:complications* / Q000473:pathology; D066127:White Matter / Q000473:pathology
Proprioception; attention; neurological examination; parietal lobe; position sense