Integrity of Medial Visuomotor Pathway Predicts Better Recovery in Neglect Patients Receiving Prism Adaptation Treatment (P02.027)

Abstract

Objective: To determine whether lesion location predicts functional recovery in right-hemisphere damaged (RHD) patients with neglect following prism adaptation therapy (PAT). Background PAT can produce substantial improvements in spatial neglect. Our previous studies suggested that PAT improved spatial bias in the motor-exploratory domain, which may be subserved by frontal cortico-subcortcial systems. Therefore, the current study examined whether frontal lesion involvement determined treatment response to PAT in post-stroke patients with spatial neglect, using motor-exploratory improvement in the Catherine Bergego Scale (CBS-ME) as the outcome measure. Design/Methods: Lesions of RHD patients (N=21) receiving PAT were manually mapped from clinical images (CT or MRI) using MRIcro. Based on the lesion maps, we extracted information of frontal vs. no-frontal lesion involvement and conducted a multilevel modeling analysis (MLM). Results: After controlling for age and lesion size, MLM revealed that patients with frontal lesions demonstrated better improvement trajectory (n=13) than patients without frontal involvement (n=8). Therefore, we pursued a more detailed analysis on lesion-symptom relationship to elucidate which frontal-subcortical systems strongly support PAT response. The PAT-responsive group had greater integrity of 1) subcortical vs. cortical and 2) medial vs. lateral structures. Conclusions: Our results showed that the medial visuomotor pathway critical for visually-guided movement may support PAT response. PAT may manipulate the network for visual sensorimotor adaptation, subserved by the spared thalamus and basal ganglia, which in turn may improve motor-exploratory behaviors related to spatial neglect. It is still unclear from our preliminary data whether dorsolateral prefrontal regions may account for other performance variables. Supported by: NIH Grants: R01NS055808-01-A2; K24HD062647-01; K02NS47099. Disclosure: Dr. Shah has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Goedert has nothing to disclose. Dr. Foundas has nothing to disclose. Dr. Barrett has received personal compensation for activities with WebMD. Dr. Barrett has received research support from the Kessler Foundation, NIH, O9Brien Technologies, Pfizer/Eisai, and the Wallerstein Foundation for Geriatric Improvement.