Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation

A case report

Martina Gandola, Anna Sedda, Marina Manera, Valeria Pingue, Gerardo Salvato, Grazia F. Spitoni, Caterina Pistarini, Ines Giorgi, Luigi Pizzamiglio, Gabriella Bottini

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions' motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself ("offline" condition) and after having performed a series of verbally cued finger opposition movements ("online" condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patient's awareness does not improve in both the "offline" condition (in which the patient does not attempt to perform the movement) and in the "online" condition, when vision is precluded ("online" condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.

Original languageEnglish
Pages (from-to)107-119
Number of pages13
JournalCortex
Volume61
DOIs
Publication statusPublished - Dec 1 2014

Fingerprint

Agnosia
Hemiplegia
Aptitude
Motor Cortex
Brain
Eye Movements
Transcranial Direct Current Stimulation
Paralysis
Fingers
Extremities

Keywords

  • Anosognosia for hemiplegia
  • Intention to move
  • Motor awareness
  • Neglect
  • Transcranial direct current stimulation

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Medicine(all)

Cite this

Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation : A case report. / Gandola, Martina; Sedda, Anna; Manera, Marina; Pingue, Valeria; Salvato, Gerardo; Spitoni, Grazia F.; Pistarini, Caterina; Giorgi, Ines; Pizzamiglio, Luigi; Bottini, Gabriella.

In: Cortex, Vol. 61, 01.12.2014, p. 107-119.

Research output: Contribution to journalArticle

Gandola, Martina ; Sedda, Anna ; Manera, Marina ; Pingue, Valeria ; Salvato, Gerardo ; Spitoni, Grazia F. ; Pistarini, Caterina ; Giorgi, Ines ; Pizzamiglio, Luigi ; Bottini, Gabriella. / Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation : A case report. In: Cortex. 2014 ; Vol. 61. pp. 107-119.
@article{c61ef44756af4b3096b6c29abdd7c687,
title = "Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation: A case report",
abstract = "Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions' motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself ({"}offline{"} condition) and after having performed a series of verbally cued finger opposition movements ({"}online{"} condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patient's awareness does not improve in both the {"}offline{"} condition (in which the patient does not attempt to perform the movement) and in the {"}online{"} condition, when vision is precluded ({"}online{"} condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.",
keywords = "Anosognosia for hemiplegia, Intention to move, Motor awareness, Neglect, Transcranial direct current stimulation",
author = "Martina Gandola and Anna Sedda and Marina Manera and Valeria Pingue and Gerardo Salvato and Spitoni, {Grazia F.} and Caterina Pistarini and Ines Giorgi and Luigi Pizzamiglio and Gabriella Bottini",
year = "2014",
month = "12",
day = "1",
doi = "10.1016/j.cortex.2014.08.007",
language = "English",
volume = "61",
pages = "107--119",
journal = "Cortex",
issn = "0010-9452",
publisher = "Masson SpA",

}

TY - JOUR

T1 - Selective improvement of anosognosia for hemiplegia during transcranial direct current stimulation

T2 - A case report

AU - Gandola, Martina

AU - Sedda, Anna

AU - Manera, Marina

AU - Pingue, Valeria

AU - Salvato, Gerardo

AU - Spitoni, Grazia F.

AU - Pistarini, Caterina

AU - Giorgi, Ines

AU - Pizzamiglio, Luigi

AU - Bottini, Gabriella

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions' motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself ("offline" condition) and after having performed a series of verbally cued finger opposition movements ("online" condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patient's awareness does not improve in both the "offline" condition (in which the patient does not attempt to perform the movement) and in the "online" condition, when vision is precluded ("online" condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.

AB - Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions' motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself ("offline" condition) and after having performed a series of verbally cued finger opposition movements ("online" condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patient's awareness does not improve in both the "offline" condition (in which the patient does not attempt to perform the movement) and in the "online" condition, when vision is precluded ("online" condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.

KW - Anosognosia for hemiplegia

KW - Intention to move

KW - Motor awareness

KW - Neglect

KW - Transcranial direct current stimulation

UR - http://www.scopus.com/inward/record.url?scp=84914151420&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84914151420&partnerID=8YFLogxK

U2 - 10.1016/j.cortex.2014.08.007

DO - 10.1016/j.cortex.2014.08.007

M3 - Article

VL - 61

SP - 107

EP - 119

JO - Cortex

JF - Cortex

SN - 0010-9452

ER -