TY - JOUR
T1 - Multiple Network Disconnection in Anosognosia for Hemiplegia
AU - Monai, Elena
AU - Bernocchi, Francesca
AU - Bisio, Marta
AU - Bisogno, Antonio Luigi
AU - Salvalaggio, Alessandro
AU - Corbetta, Maurizio
N1 - Funding Information:
MC was supported by a starting grant of the University of Padua “FC-Neuro”, NIH RO1 NS095741, and ERA FLAG II: “Brainsynch-Hit”.
Funding Information:
Funding. MC was supported by a starting grant of the University of Padua ?FC-Neuro?, NIH RO1 NS095741, and ERA FLAG II: ?Brainsynch-Hit?.
Publisher Copyright:
© Copyright © 2020 Monai, Bernocchi, Bisio, Bisogno, Salvalaggio and Corbetta.
PY - 2020/4/29
Y1 - 2020/4/29
N2 - Anosognosia for hemiplegia (AHP) is a complex syndrome whose neural correlates are still under investigation. One hypothesis, mainly based on lesion mapping studies, is that AHP reflects a breakdown of neural systems of the right hemisphere involved in motor function. However, more recent theories have suggested that AHP may represent a disorder of cognitive systems involved in belief updating, self-referential or body processing. Two recent studies, using a method to estimate the degree of white matter disconnection from lesions, have indeed shown that patients with AHP suffer from damage of several long-range white matter pathways in association cortex. Here, we use a similar indirect disconnection approach to study a group of patients with motor deficits without anosognosia (hemiparesis or hemiplegia, HP, n = 35), or motor deficits with AHP (n = 28). The HP lesions came from a database of stroke patients, while cases of AHP were selected from the published literature. Lesions were traced into an atlas from illustrations of the publications using a standard method. There was no region in the brain that was more damaged in AHP than HP. In terms of structural connectivity, AHP patients had a similar pattern of disconnection of motor pathways to HP patients. However, AHP patients also showed significant disconnection of the right temporo-parietal junction, right insula, right lateral and medial prefrontal cortex. These associative cortical regions were connected through several white matter tracts, including superior longitudinal fasciculus III, arcuate, fronto-insular, frontal inferior longitudinal, and frontal aslant. These tracts connected regions of different cognitive networks: default, ventral attention, and cingulo-opercular. These results were not controlled for clinical variables as concomitant symptoms and other disorders of body representation were not always available for co-variate analysis. In conclusion, we confirm recent studies of disconnection demonstrating that AHP is not limited to dysfunction of motor systems, but involves a much wider set of large-scale cortical networks.
AB - Anosognosia for hemiplegia (AHP) is a complex syndrome whose neural correlates are still under investigation. One hypothesis, mainly based on lesion mapping studies, is that AHP reflects a breakdown of neural systems of the right hemisphere involved in motor function. However, more recent theories have suggested that AHP may represent a disorder of cognitive systems involved in belief updating, self-referential or body processing. Two recent studies, using a method to estimate the degree of white matter disconnection from lesions, have indeed shown that patients with AHP suffer from damage of several long-range white matter pathways in association cortex. Here, we use a similar indirect disconnection approach to study a group of patients with motor deficits without anosognosia (hemiparesis or hemiplegia, HP, n = 35), or motor deficits with AHP (n = 28). The HP lesions came from a database of stroke patients, while cases of AHP were selected from the published literature. Lesions were traced into an atlas from illustrations of the publications using a standard method. There was no region in the brain that was more damaged in AHP than HP. In terms of structural connectivity, AHP patients had a similar pattern of disconnection of motor pathways to HP patients. However, AHP patients also showed significant disconnection of the right temporo-parietal junction, right insula, right lateral and medial prefrontal cortex. These associative cortical regions were connected through several white matter tracts, including superior longitudinal fasciculus III, arcuate, fronto-insular, frontal inferior longitudinal, and frontal aslant. These tracts connected regions of different cognitive networks: default, ventral attention, and cingulo-opercular. These results were not controlled for clinical variables as concomitant symptoms and other disorders of body representation were not always available for co-variate analysis. In conclusion, we confirm recent studies of disconnection demonstrating that AHP is not limited to dysfunction of motor systems, but involves a much wider set of large-scale cortical networks.
KW - anosognosia
KW - awareness
KW - hemiplegia
KW - network
KW - stroke
KW - structural disconnection
UR - http://www.scopus.com/inward/record.url?scp=85084587715&partnerID=8YFLogxK
U2 - 10.3389/fnsys.2020.00021
DO - 10.3389/fnsys.2020.00021
M3 - Article
C2 - 32410965
AN - SCOPUS:85084587715
VL - 14
JO - Frontiers in Systems Neuroscience
JF - Frontiers in Systems Neuroscience
SN - 1662-5137
M1 - 21
ER -