An experimental investigation on the nature of extinction

doi:10.1016/0028-3932(94)00111-2

Neuropsychologia

Volume 33, Issue 2, February 1995, Pages 153-170

https://doi.org/10.1016/0028-3932(94)00111-2 Get rights and content

Abstract

Under conditions of bilateral simultaneous presentation a right brain-damaged patient consistently extinguished visual stimuli presented for 200 msec to the left visual field. He was submitted to a series of experiments aimed at assessing the variables that influence this phenomenon. Extinction persisted unmodified when stimulus presentation was lengthened to 500 msec, when the size of the left stimulus was four-fold that of the right stimulus and for whatever position the stimuli occupied on the two halves of the display. Single stimuli were always perceived, but their localization was transposed rightward. The only condition in which extinction was partially reduced was when the instructions called for total disregard of the right stimulus. The patient also extinguished the leftmost of two stimuli presented in the left space, while he always perceived both stimuli when they were presented in the right space. However, if attention was covertly moved to a point in the right space and two stimuli were displayed to either side of it, left stimuli were neglected 70% of the time. Though a left stimulus was never perceived, it slowed the RT to the identification of a right stimulus. These data are interpreted in the frame of the directional bias theory, which attributes extinction to a shift of attention towards the side ipsilateral to the lesion, caused by the imbalance between the opponent turning processors, controlled by the right and left hemisphere. However, the striking difference in the rate of extinction when both stimuli were presented to the left or to the right field implies a stepwise decrement in the deployment of attention by the damaged processor, when it enters in the opposite space.

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Investigating visuo-spatial neglect and visual extinction during intracranial electrical stimulations: The role of the right inferior parietal cortex
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Citation Excerpt :
Early accounts of extinction were in terms of sensory impairment (Bender, 1952), according to which it might result from sensory imbalance due to weakened or delayed afferent inputs in the affected hemisphere rather than from attentional factors. By contrast, more recent interpretations suggest that higher-order processing impairments contribute to extinction, which is considered a neglect syndrome component (Bisiach and Vallar, 2000; di Pellegrino and de Renzi, 1995; Vallar, 1998, Box 2). Extinction of the visual or tactile contralateral stimulus may occur after both left and right brain damage, but a closer association with damage to the right hemisphere has been repeatedly reported (Bisiach et al., 1989; Gainotti et al., 1989; Meador et al., 1988; Schwartz et al., 1979; Becker and Karnath, 2007).
Both visuo-spatial neglect and visual extinction may occur following right-brain damage. So far, studies on brain-damaged patients have not provided definite evidence about which lesion patterns may lead to the association or dissociation of these deficits. This study was set out to address this issue using Intracranial Electrical Stimulation (IES) in a group of nine patients affected by refractory epilepsy. Cerebral regions associated with visuo-spatial neglect and visual extinction were stimulated, including the right frontal, temporal, and posterior parietal areas. During IES, patients with intracranial implantation involving at least one of these cortical regions were administered with a manual line bisection task (N = 9) to assess visuo-spatial neglect, and a computerized task (N = 8) assessing visual extinction. Results showed that parietal IES induced a rightward bias at the manual bisection task, together with a general improvement in reaction times at bilateral and unilateral visual stimuli detection at the extinction task. The occurrence of visual extinction did not vary across stimulations. By adopting a complementary approach to anatomo-clinical correlation studies, our work corroborates the notion that lesions to the right inferior parietal lobule play a pivotal role in the pathogenesis of visuo-spatial neglect. Importantly, our results also suggest that temporarily interfering with the activity of this region is not sufficient per se to generate visual extinction, which instead may involve a broader and/or different network, possibly extending beyond the cerebral regions considered here, posing important theoretical and clinical implications.
The central role of the temporo-parietal junction and the superior longitudinal fasciculus in supporting multi-item competition: Evidence from lesion-symptom mapping of extinction
2013, Cortex
The present study examined the relations between the lesions linked to visual and tactile extinction (VE and TE), and those related to visual field defects and spatial neglect. Continuous variations in patients’ performance were used to assess the link between behavioural scores and integrity of both grey and white matter (GM and WM). We found both common and distinct neural substrates associated with extinction and neglect. Damage to angular and middle occipital gyri, superior temporal sulcus (STS) and insula were linked to VE. Lesions involving the supramarginal gyrus (SMG), intraparietal sulcus, middle frontal and superior temporal gyri (MFG and STG) were associated exclusively with spatial neglect. Lesions affecting the temporo-parietal junction (TPJ), the middle temporal region, middle frontal area (BA46) as well as the insula and putamen were linked to both spatial neglect and VE. Analysis of the relations between VE and TE highlighted the TPJ as the common site for both modalities. These findings suggest that the TPJ plays a general role in identifying salient events in the sensory environment across multiple modalities. Furthermore, WM analyses pointed to superior longitudinal fasciculus (SLF) as critical for interconnecting components of the visuospatial attention network. We demonstrated that functional disconnections resulting from SLF damage contribute to altered performance on attention tasks measuring not only neglect but also VE and TE. We propose that the SLF supports interactions between functionally specialized regions involved in attentional control across multiple sensory modalities.
Mechanisms and anatomy of unilateral extinction after brain injury
2012, Neuropsychologia
Citation Excerpt :
Although impaired processing of single contralesional stimuli after unilateral brain damage can occur in absence of extinction (Habekost & Rostrup, 2006; Smania et al., 1998), the severity of impairments for single contralesional processing has been shown to correlate with extinction severity (Habekost & Rostrup, 2006; Marzi et al., 1996; Schwartz et al., 1979). Furthermore, extinction severity can be ameliorated by increasing the sensory signal strength of the contralesional stimulus (di Pellegrino & de Renzi, 1995; Kluger et al., 2008; Oppenheim, 1885; Pavlovskaya, Soroker, & Bonneh, 2007). On the other hand, extinction is not fully abolished even if the strengths of the contralesional and ipsilesional sensory signal are equated by measuring detection thresholds separately for each side on unilateral trials, then setting the stimulus strengths during double stimulation relative to those separate single thresholds (Pavlovskaya et al., 2007, see Fig. 1).
Unilateral extinction is a common consequence of unilateral brain injury in which individuals fail to detect a contralesional target when presented together with a competing ipsilesional target. Here we review the literature on the different mechanisms and anatomy hypothesized to underlie unilateral extinction. We argue that extinction, which reflects a specific deficit in the simultaneous processing of multiple briefly presented targets, should be distinguished from the failure to actively explore and serially detect targets amongst distractors in contralesional space commonly known as spatial neglect. While contralesional sensory defects can be correlated with extinction, these sensory impairments alone are usually not sufficient to explain the deficit. Prototypical extinction is instead best seen as the result of a pathologically biased competition between multiple target representations for pathologically limited attentional resources. The temporo-parietal junction (TPJ) is a critical site in many of the lesions that provoke extinction. Additionally, the intraparietal sulcus (IPS) may play a role in modulation of competitive interactions between multiple target representations.
Spatial attention deficits in humans: The critical role of superior compared to inferior parietal lesions
2012, Neuropsychologia
Citation Excerpt :
This interference effect depends on the relative position of the distracter with respect to the target: if the distracter is on the same horizontal axis as the target, interference is much stronger than when it is on a vertical axis with respect to the target or on a diagonal axis (Fig. 2a) (Molenberghs et al., 2008). The interference is present regardless of whether target and distracter are presented symmetrically or asymmetrically between hemifields (di Pellegrino & deRenzi, 1995) or within hemifields (Molenberghs et al., 2008). According to a VLSM analysis of 20 cases with unifocal cortical lesions, the interference effect is associated with damage of IPL, extending into the lower bank of IPS (Fig. 2b, green) (Molenberghs et al., 2008).
According to a longstanding view, inferior as opposed to superior parietal cortex critically contributes to the spatial attentional deficits encountered following unilateral parietal ischemic lesions. We review the evidence on which this view is based and contrast it with more recent structural lesion evidence concerning the critical role of the intraparietal sulcus in spatial attention deficits. In a classical spatial cueing paradigm, focal lesions of the posterior and of the middle segment of the intraparietal sulcus give rise to a pathological invalidity effect that is indistinguishable from that seen after classical inferior parietal lesions. When a competing distracter is added to a target stimulus, the deleterious consequences of focal IPS lesions are again very similar to those classically observed following inferior parietal lesions. The deficit could not be accounted for by functional effects at a distance affecting inferior parietal cortex. These single-case lesion data establish the critical role of the posterior and the middle IPS segment in spatially selective attention and are in line with a vast amount of functional imaging evidence in the intact brain pointing to the prominent role of the intraparietal sulcus in spatial attention, along with inferior parietal cortex under specific circumstances. Functional imaging has also provided hints about the differences in functional contribution between inferior and superior parietal cortex. These hypotheses await further confirmation based on lesion evidence.
Auditory extinction and spatio-temporal order judgment in patients with left- and right-hemisphere lesions
2012, Neuropsychologia
Citation Excerpt :
Some authors argue for a sensory component underlying extinction based on lesions affecting the ascending pathway and/or sensory cortex (De Renzi et al., 1984; Vallar et al., 1994). Contrasting this notion are the findings of (i) the intact perception of singular unilateral stimuli (Baylis et al., 2002; Di Pellegrino & De Renzi, 1995), (ii) extinction after non-sensory cortex lesions (De Renzi et al., 1984; Karnath et al., 2003; Rorden, Mattingley, Karnath, & Driver, 1997), and (iii) the implicit processing of information about extinguished stimuli (Deouell & Soroker, 2000; Shisler, Gore, & Baylis, 2004). Alternative explanations assume an underlying attentional deficit (Kerkhoff, 2001), based on the notion of two opponent hemispheric processors, each of them directing attention toward the contralateral side of space.
Auditory extinction and spatio-temporal order judgment (STOJ) were assessed in patients with acquired brain damage by systematically manipulating onset times in bilateral stimulation under free-field conditions. We tested the hypothesis that extinction will be reduced by increasing stimulus onset asynchrony. Two groups of patients with right-hemisphere (RH, n = 17) or left-hemisphere (LH, n = 17) damage were investigated in comparison to a healthy control group (n = 12). The patients were recruited based on previously diagnosed impairments: auditory discrimination deficits with (RH_E/LH_E) or without extinction (RH₀/LH₀) due to cortical and/or subcortical temporo-parietally centred lesions. Stimuli were presented bilaterally in the acoustic free-field, with an onset asynchrony of ±30 to ±150 ms, or unilaterally, from speakers located ±60°. Low frequency (LF) and high frequency (HF) stimuli were used to address spatial auditory processing in the horizontal plane based on the two main cues of interaural time and interaural intensity differences, respectively. The subjects’ task was to indicate whether they perceived one (left or right) or two stimuli (left and right), and in the case of two make an STOJ (left or right first). Temporal asynchrony significantly reduced extinction in those patients that previously exhibited extinction for bilateral-simultaneous stimulation (RH_E/LH_E). In addition, their error rates in STOJ were higher than the controls’. A number of patients with no previous signs of extinction in bilateral-simultaneous stimulation (RH₀/LH₀) also showed impaired STOJ: in RH₀ patients this was specific to ipsilesional-leading stimuli, whilst in LH₀ patients no side-specific effect was observed. The data support the notion of differential roles for the two hemispheres in spatio-temporal auditory perception and are discussed with respect to prevalent models of extinction and its possible long-term reduction.
Horizontal and vertical dimensions of visual extinction: a theta burst stimulation study
2009, Neuroscience
After a lesion of the posterior parietal cortex (PPC), the perception of a contra-lesional stimulus in presence of a simultaneous, ipsilesional stimulus may be impaired, a phenomenon referred to as visual extinction. In the present study, visual extinction was transiently induced in healthy subjects by interfering with the function of the right PPC by means of continuous theta burst stimulation (TBS). We investigated to which extent the horizontal and vertical position of visual stimuli influenced the extinction rate. A single TBS train over the right PPC induced a significant increase of left visual extinctions of at least 30 min. Left visual extinction rate was higher when the left sided visual stimulus was presented at a more eccentric position on the horizontal axis (irrespective of right sided visual stimulus position) and in the lower part of the visual field. The results are discussed within the framework of current explanatory models and of putative inter- and intrahemispheric mechanisms directing visuospatial attention.

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An experimental investigation on the nature of extinction

Abstract

Cortex

Brain Cognit.

Neuropsychologia

Cortex

Neuropsychologia

Neuropsychologia

Cortex

Neuropsychologia

A simple test of visual neglect

Neurology

Patterns of neglect dissociations

Behav. Neurol.

Unilateral ‘spatial agnosia’ (‘inattention’) in patients with cerebral lesions

Brain

Visual extinction and stimulus repetition

J. Cognit. Neurosci.

Disorders in Perception

Visual processing without awareness: Evidence from unilateral neglect

J. Cognit. Neurosci.

Disorders of perceived auditory lateralization after lesions of the right hemisphere

Brain

Anosognosia related to hemiplegia and hemianopia