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.

KEYWORDS:

• Spatial neglect
• real-time functional magnetic resonance imaging
• neurofeedback
• self-regulation
• visual cortex

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Fondation Leenaards, the Swiss Nartional Science Foundation (grant 166704 to PV), and a BRIDGE Marie Curie FP7 Fellowship from the European Union Seventh Framework Programme [grant number FP7/2007–2013; COFUND Project N°267171] to FR. FS was funded by an Ambizone and Starting Grant from the Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung [grant numbers PZ00P3-131932, BSSG10_155915]. PV received support from the Société Académique de Genève [Foremane Fund].