title: Using real-time fMRI neurofeedback to restore right occipital cortex activity in patients with left visuo-spatial neglect: proof-of-principle and preliminary results.
abstract: Hemineglect is common after right parietal stroke, characterised by impaired awareness for stimuli in left visual space, with suppressed neural activity in the right visual cortex due to losses in top-down attention signals. Here we sought to assess whether hemineglect patients are able to up-regulate their right visual cortex activity using auditory real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback. We also examined any effect of this training procedure on neglect severity. Two different neurofeedback methods were used. A first group of six patients was trained to up-regulate their right visual cortex activity and a second group of three patients was trained to control interhemispheric balance between their right and left visual cortices. Over three sessions, we found that the first group successfully learned to control visual cortex activity and showed mild reduction in neglect severity, whereas the second group failed to control the feedback and showed no benefit. Whole brain analysis further indicated that successful up-regulation was associated with a recruitment of bilateral fronto-parietal areas. These findings provide a proof of concept that rt-fMRI neurofeedback may offer a new approach to the rehabilitation of hemineglect symptoms, but further studies are needed to identify effective regulation protocols and determine any reliable impact on clinical symptoms.
authors.affiliation: a Laboratory of Behavioural Neurology and Imaging of Cognition, Department of Neuroscience , University Medical Center , Geneva , Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Robineau
authors.affiliation: a Laboratory of Behavioural Neurology and Imaging of Cognition, Department of Neuroscience , University Medical Center , Geneva , Switzerland.|b Department of Neurology , University Hospital , Geneva , Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Saj
authors.affiliation: a Laboratory of Behavioural Neurology and Imaging of Cognition, Department of Neuroscience , University Medical Center , Geneva , Switzerland.
authors.forename: Rémi
authors.initials: R
authors.lastname: Neveu
authors.affiliation: c Department of Radiology and Medical Informatics , CIBM, University of Geneva , Geneva , Switzerland.|d Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne , Switzerland.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Van De Ville
authors.affiliation: c Department of Radiology and Medical Informatics , CIBM, University of Geneva , Geneva , Switzerland.|d Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne , Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Scharnowski
authors.affiliation: a Laboratory of Behavioural Neurology and Imaging of Cognition, Department of Neuroscience , University Medical Center , Geneva , Switzerland.|b Department of Neurology , University Hospital , Geneva , Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Vuilleumier
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D058765:Neurofeedback / Q000379:methods; D009778:Occipital Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010468:Perceptual Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D013028:Space Perception / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods; D016896:Treatment Outcome; D014796:Visual Perception / Q000502:physiology*
keywords: Spatial neglect; neurofeedback; real-time functional magnetic resonance imaging; self-regulation; visual cortex