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DOI: 10.1055/s-2004-834706
Motorische Vernachlässigungsphänomene
Motor Aspects of Neglect and Related Disorders GRF wird von der Deutschen Forschungsgemeinschaft (DFG-KFO 112) unterstütztPublikationsverlauf
Publikationsdatum:
16. August 2005 (online)
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Zusammenfassung
Viele Patienten, die eine fokale Schädigung ihres Gehirns (z. B. durch einen Schlaganfall oder ein Schädel-Hirn-Trauma) überleben, behalten kognitive Einbußen zurück, die sich nachteilig auf ihre weitere Behandlung und Rehabilitation auswirken. Unilateraler (oder räumlicher) Neglect ist ein solches kognitives Defizit, das die Effektivität der neurologischen Rehabilitation nach einem Schlaganfall besonders stark beeinträchtigt und zu gravierenden Einschränkungen im alltäglichen Leben der Patienten führt [1]. Unter dem Begriff (Hemi- oder räumlicher) Neglect werden Symptome zusammengefasst, die mit einer (halbseitigen) Vernachlässigung des extra-, peri- und/oder personalen Raums einhergehen und die nicht primär durch Störungen der Sensorik oder Motorik bedingt sind [2]. Patienten mit Neglect haben Schwierigkeiten, ihre Aufmerksamkeit in die vernachlässigte kontraläsionale Raumhälfte zu wenden und auf Reize aus dieser Raumhälfte adäquat zu reagieren. Nach gegenwärtigem Kenntnisstand ist es sinnvoll, perzeptive von motorischen Neglectsymptomen abzugrenzen; letztere sind dadurch gekennzeichnet, dass die vom Schlaganfall primär mitbetroffene (kontralaterale), aber nicht plegische Körperhälfte nicht aktiv eingesetzt wird [3], dass aber auch die ipsilaterale vom Schlaganfall primär nicht betroffene Körperhälfte in ihrer aktiven Nutzung eingeschränkt sein kann. Motorischer Neglect beschreibt somit eine verminderte spontane Nutzung der betroffenen Körperhälfte(n) (oder Extremität[en]), die nicht durch das Pareseausmaß, sondern durch eine motorische Aufmerksamkeitsstörung zu erklären ist. Motorischer Neglect führt zu einer Einschränkung der aktiven Teilnahme am Alltag und den Rehabilitationsprogrammen und ist deswegen mit einer schlechteren funktionellen und sozialen Prognose assoziiert. Aus diesem Grunde ist es wichtig, motorische Aspekte räumlicher Neglectsyndrome und verwandter Störungen rechtzeitig zu erkennen.
Abstract
Many patients who survive brain damage (resulting from, e. g., a stroke) are left with a variety of cognitive impairments which adversely affect their treatment, management, and hence also their subsequent recovery. Unilateral neglect is one such cognitive deficit which severely limits the effectiveness of rehabilitation, and curtails many aspects of everyday life [1]. Neglect is not a well-defined syndrome but may rather present as a protean disorder with different behavioural manifestations which share in common the patient's failure to spontaneously report, respond or even orient to objects and events in the hemispace contralateral to a brain lesion, and which cannot be attributed to either primary sensory or motor deficits [2]. Although many manifestations of neglect can be explained in terms of a failure to attend to or perceive objects located in contralesional space (i. e., perceptual neglect), neuropsychological evidence also suggests that neglect can result from response problems (i. e., disorders of action), which in the neglect literature are often referred to as „motor” and „pre-motor” neglect. Motor neglect behaviour is characterized by a „difficulty” to use the contralesional limb spontaneously or to use the ipsilesional limb appropriately when moving into contralesional space. Motor neglect thus refers to a reduced spontaneous use of the affected limb which cannot be explained by a primary motor deficit but rather results from a disorder of motor attention (or intention). Motor neglect behaviour leads to a reduced participation in many activities of daily living and is hence a poor prognostic factor. This bad influence on the patient's outcome necessitates an early diagnosis and treatment of motor forms of neglect.
Literatur
- 1 Halligan P W, Cockburn J. Cognitive sequelae of stroke: Visuospatial and memory disorders. Critical Reviews in Physical and Rehabilitation Medicine. 1993; 5 57-81
- 2 Fink G R, Heide W. Räumlicher Neglect. Nervenarzt. 2004; 75 389-410
- 3 Laplane D, Degos J D. Motor neglect. J Neurol Neurosurg Psychiatr. 1983; 46 152-158
- 4 Heilman K M, Valenstein E, Watson R T. Neglect and related disorders. Seminars in Neurology. 2000; 20 463-470
- 5 Vallar G. Extrapersonal visual unilateral spatial neglect and its neuroanatomy. NeuroImage. 2001; 14 S52-S58
- 6 Doricchi F, Tomaiuolo F. The anatomy of neglect without hemianopia: a key role for parietal-frontal disconnection. Neuroreport. 2003; 14 2239-2243
- 7 Vallar G, Perani D, Cappa S F. et al . Recovery from aphasia and neglect after subcortical stroke: neuropsychological and cerebral perfusion study. J Neurol Neurosurg Psychiatr. 1998; 51 1269-1276
- 8 Halligan P W, Fink G R, Marshall J C. et al . Spatial cognition: evidence from visual neglect. Trends in Cognitive Sciences. 2003; 7 125-133
- 9 Mort D J, Malhotra P, Mannan S K. et al . The anatomy of visual neglect. Brain. 2003; 126 1986-1997
- 10 Poppelreuter W. Die psychischen Schädigungen durch Kopfschuss im Kriege 1914/16. Leipzig; Leopold Voss 1917
- 11 Liepmann H. Drei Aufsätze aus dem Apraxiegebiet. Berlin; Karger 1908
- 12 Liepmann H. Die linke Hemisphäre und das Handeln. Münchner Medizinische Wochenschrift. 1905; 49 2375-2378
- 13 Assmus A, Marshall J C, Ritzl A. et al . Left inferior parietal cortex integrates time and space during collision judgments. NeuroImage. 2003; 20 S82-S88
- 14 Jackson J H. Case of large cerebral tumour without optic neuritis and with left hemiplegia and imperception. Royal London Ophthalmic Hospital Reports. 1876; 8 434-444
- 15 Balint R. Seelenlähmung des Schauens, optische Ataxie, räumliche Störung der Aufmerksamkeit. Monatsschrift für Psychiatrie und Neurologie. 1909; 25 51-81
- 16 Brain W R. Visual disorientation with special reference to lesions of the right hemisphere. Brain. 1941; 64 244-272
- 17 Halligan P W, Marshall J C. Left neglect for near but not far space in man. Nature. 1991; 350 498-500
- 18 Vuilleumier P, Valenza N, Mayer E. et al . Near and far visual space in unilateral neglect. Ann Neurol. 1998; 43 406-410
- 19 Rizzolatti G, Fadiga L, Fogassi L. et al . The space around us. Science. 1997; 277 190-191
- 20 Weiss P H, Marshall J C, Wunderlich G. et al . Neural consequences of acting in near versus far space: a physiological basis for clinical dissociations. Brain. 2000; 123 2531-2541
- 21 Weiss P H, Marshall J C, Zilles K. et al . Are action and perception in near and far space additve or interactive factors?. NeuroImage. 2003; 18 837-846
- 22 Bjoertomt O, Cowey A, Walsh V. Spatial neglect in near and far space investigated by repetitive transcranial magnetic stimulation. Brain. 2002; 125 2012-2022
-
23 Bridgeman B.
Separate representations of visual space for perception and visually guided behavior. In: Aschersleben G, Bachmann T, Müsseler J (eds) Cognitive Contributions to the Perception of Spatial and Temporal Events. Amsterdam; Elsevier Science 1999 - 24 Castaigne P, Laplane D, Degos J D. Trois cas de négligence notrice par lesion rétrorolandique. Rev Neurol (Paris). 1970; 122 234-242
- 25 Castaigne P, Laplane D, Degos J D. Trois cas de négligence motrice par lésion frontale pré-rolandique. Rev Neurol (Paris). 1972; 126 5-15
- 26 Critchley M. The parietal lobes. New York; Hafner 1953
- 27 Valenstein E, Heilman K M. Unilateral hypokinesia and motor extinction. Neurology. 1981; 31 445-448
- 28 Viader F, Cambier J, Pariser P. Left motor extinction due to an ischemic lesion of the anterior limb of the internal capsule. Rev Neurol (Paris). 1982; 138 213-217
- 29 Ghika J, Ghika-Schmid F, Bogousslavski J. Parietal motor syndrome: a clinical description in 32 patients in the acute phase of pure parietal strokes studied prospectively. Clin Neurol Neurosurg. 1998; 100 271-281
- 30 Robertson I H, North N. Spatio-motor cueing in unilateral neglect: The role of hemispace, hand and motor activation. Neuropsychologia. 1992; 30 553-563
- 31 Robertson I H, Marshall J C. Unilateral neglect: Clinical and experimental findings. Hillsdale, NJ; Erlbaum 1993
-
32 Vallar G, Guariglia C, Rusconi M L.
Modulation of the neglect syndrome by sensory stimulation. In: Thier P, Karnath H-O (eds) Parietal Lobe Contributions to Orientation in 3D Space. Heidelberg; Springer-Verlag 1997: 555-578 - 33 Watson R T, Miller B, Heilman K M. Nonsensory neglect. Ann Neurol. 1978; 3 505-508
- 34 Marshall J C, Halligan P W. Within- and between-task dissociations in visuo-spatial neglect: a case study. Cortex. 1995; 31 367-376
- 35 Giesen H J von, Schlaug G, Steinmetz H. et al . Cerebral network underlying unilateral motor neglect: evidence from positron emission tomography. J Neurol Sci. 1994; 125 29-38
- 36 Classen J, Schnitzler A, Binkofski F. et al . The motor syndrome associated with exaggerated inhibition within primary motor cortex. Brain. 1997; 120 605-619
- 37 Bisiach E, Geminiani G, Berti A. et al . Perceptual and premotor factors of unilateral neglect. Neurology. 1990; 40 1278-1281
-
38 Bisiach E.
Perception and action in space representation: evidence from unilateral neglect. In: d'Ydewalle G, Eele P, Bertelson P (eds) International Perspectives on Psychological Science. Hove; Erlbaum 1994 - 39 Bisiach E, Tegner R, Ladavas E. et al . Dissociation of ophthalmokinetic and melokinetic attention in unilateral neglect. Cereb Cortex. 1995; 5 439-447
- 40 Bisiach E, Ricci R, Lualdi M. et al . Perceptual and response bias in unilateral neglect. Brain and Cognition. 1998; 37 369-386
- 41 Heilman K M, Bowers D, Coslett H B. et al . Directional hypokinesia: prolonged reaction times for leftward movements in patients with right hemisphere lesions and neglect. Neurology. 1985; 35 855-859
- 42 Mattingley J B, Bradshaw J L, Bradshaw J A. et al . Recovery from directional hypokinesia and bradykinesia in unilateral neglect. J Clin Exp Neuropsychol. 1994; 16 861-876
-
43 Mattingley J B, Driver J.
Distinguishing sensory and motor deficits after parietal damage: An evaluation of response selection biases in unilateral neglect. In: Thier P, Karnath H-O (eds) Parietal Contributions to Orientation in 3D Space. Heidelberg; Springer 1997: 309-338 - 44 Mattingley J B, Husain M, Rorden C. et al . Motor role of human inferior parietal lobe revealed in unilateral neglect patients. Nature. 1998; 392 179-182
- 45 Girotti F, Casazza M, Musicco M. et al . Oculomotor disorders in cortical lesions in man: the role of unilateral neglect. Neuropsychologia. 1983; 21 543-553
- 46 Chédru F, Léblanc M, Lhermitte F. Visual searching in normal and brain damaged subjects: contributions to the study of unilateral inattention. Cortex. 1973; 9 94-111
- 47 Hornak J. Ocular exploration in the dark by patients with visual neglect. Neuropsychologia. 1992; 30 547-552
- 48 Ishiai S, Furukawa T, Tsukagoshi H. Eye-fixation patterns in homonymous hemianopia and unilateral spatial neglect. Neuropsychologia. 1987; 25 675-679
- 49 Meador K J, Watson R T, Bowers D. et al . Hypometria with hemispatial and limb motor neglect. Brain. 1986; 109 293-305
- 50 Meador K J, Moore E E, Martin R C. et al . Limb and hemispatial hypometria. J Int Neuropsychol Soc. 2000; 6 71-75
- 51 Heilman K M, Bowers D, Watson R T. Performance on hemispatial pointing task by patients with neglect syndrome. Neurology. 1983; 33 661-664
- 52 Renzi E De, Faglioni P, Scotti G. Hemispheric contribution to exploration of space through the visual and tactile modality. Cortex. 1970; 6 191-203
- 53 Renzi E De. Disorders of space exploration and cognition. New York; Wiley 1982
-
54 Heilman K M, Watson R T.
Intentional motor disorders. In: Levin HS, Eisenberg HM, Benton AL (eds) Frontal Lobe Function and Dysfunctions. New York; Oxford University Press 1991 - 55 Halligan P W, Marshall J C. Perceptual cueing and perceptuo-motor compatibility in visuo-spatial neglect: a single case study. Cognitive Neuropsychology. 1989; 6 423-435
- 56 Tegner R, Levander M. Through a looking glass: a new technique to demonstrate directional hypokinesia in unilateral neglect. Brain. 1991; 114 1943-1951
- 57 Na L D, Adair J C, Williamson D J. et al . Dissociation of sensory-attentional from motor-intentional neglect. J Neurol Neurosurg Psychiatr. 1998; 64 331-338
- 58 Halligan P W, Marshall J C. Left visuospatial neglect: A meaningless entity?. Cortex. 1992; 28 525-535
- 59 Bremmer F, Schlack A, Shah N J. et al . Polymodal motion processing in posterior parietal and premotor cortex: a human fMRI study strongly implies equivalencies between humans and monkeys. Neuron. 2001; 29 287-296
- 60 Grefkes C, Weiss P H, Zilles K. et al . Crossmodal Processing of object features in human anterior intraparietal cortex. A fMRI study implies equivalencies between humans and monkeys. Neuron. 2002; 35 173-184
- 61 Matelli M, Luppino G. Parietofrontal circuits for action and space perception in the macaque monkey. NeuroImage. 2001; 14 S27-S32
- 62 Heilman K M, Valenstein E. Mechanisms underlying hemispatial neglect. Ann Neurol. 1979; 5 166-170
-
63 Bisiach E, Vallar G.
Unilateral neglect in humans. In: Boller F, Grafman J, Rizzolatti G (eds) Handbook of Neuropsychology. Amsterdam; Elsevier 2000: 459-502 - 64 Rizzolatti G, Berti A. Neglect as a neural representation deficit. Rev Neurol. 1990; 146 626-634
- 65 Rizzolatti G, Fogassi L, Gallese V. Parietal cortex: from sight to action. Curr Opin Neurobiol. 1997; 7 562-567
- 66 Mesulam M M. A cortical network for directed attention and unilateral neglect. Ann Neurol. 1981; 10 309-325
- 67 Mesulam M M. Large-scale neurocognitive networks and distributed processing for attention, language, and memory. Ann Neurol. 1990; 28 597-613
- 68 Mesulam M M. The multiplicity of neglect phenomena. Neuropsychological Rehabilitation. 1994; 4 173-176
- 69 Andersen R A, Snyder L H, Bradlet D C. et al . Multimodal representation of space in the posterior parietal cortex and its use in planning movements. Annual Review of Neuroscience. 1997; 20 300-330
- 70 Andersen R A, Snyder L H, Batista A P. et al . Posterior parietal areas specialized for eye movements (LIP) and reach (PRR) using a common coordinate frame. Novartis Found Symp. 1998; 218 109-122
- 71 Andersen R A, Shenoy K V, Snyder L H. et al . The contributions of vestibular signals to the representations of space in the posterior parietal cortex. Ann N Y Acad Sci. 1999; 871 282-292
- 72 Andersen R A, Buneo C A. Intentional maps in posterior parietal cortex. Annu Rev Neurosci. 2002; 25 189-230
- 73 Bremmer F, Schlack A, Duhamel J-R. et al . Space coding in primate posterior parietal cortex. NeuroImage. 2001; 14 S46-S51
- 74 Fink G R, Marshall J C, Weiss P H. et al . Performing allocentric visuospatial judgments with induced distortion of the egocentric reference frame: an fMRI study with clinical implications. NeuroImage. 2003; 20 1505-1517
- 75 Vogeley K, Fink G R. Neural correlates of the first-person perspective. Trends in Cognitive Sciences. 2003; 7 38-42
- 76 Marshall J C, Fink G R. Spatial cognition: Where we were and where we are. NeuroImage. 2001; 14 S2-S7
- 77 Pouget A, Sejnowski T J. Simulating a lesion in a basis function model of spatial representations: Comparison with hemineglect. Psychological Review 2001
- 78 Boussaoud D, Pellegrino G di, Wise S P. Frontal lobe mechanisms subserving vision-for-action versus vision-for-perception. Behavioural Brain Research. 1996; 72 1-15
- 79 Boussaoud D. Attention versus intention in the primate premotor cortex. NeuroImage. 2001; 14 S40-S45
-
80 Kinsbourne M.
Orientational bias model of unilateral neglect: evidence from attentional gradients within hemispace. In: Roberson IH, Marshall JC (eds) Unilateral Neglect: Clinical and Experimental Findings. Hove; Erlbaum 1993: 63-86 - 81 Bartolomeo P, Chokron S, Gainotti G. Laterally directed arm movements and right unilateral neglect after left hemisphere damage. Neuropsychologia. 2001; 39 1013-1021
- 82 Fisher M. Left hemiplegia and motor impersistence. J Nerv Ment Dis. 1956; 123 201-218
- 83 Kertesz A, Nicholson I, Cancelliere A. et al . Motor impersistence: a right-hemisphere syndrome. Neurology. 1985; 35 662-666
- 84 Roeltgen M G, Roeltgen D P, Heilman K M. Unilateral motor impersistence and hemispatial neglect from a striatal lesion. Neuropsychiatry, Neuropsychology and Behavioral Neurology. 1989; 2 125-135
- 85 Jackson S R. Motor aspects of hemispatial neglect. Behavioural Neurology. 2001; 13 1-2
- 86 Goodale M A, Milner A D. Separate visual pathways for perception and action. Trends in Neuroscience. 1993; 15 20-25
- 87 Verfaellie M, Bowers D, Heilman K M. Hemispheric asymmetries in mediating intention, but not selective attention. Neuropsychologia. 1988; 26 521-531
- 88 Verfaellie M, Bowers D, Heilman K M. Attentional factors in the occurence of stimulus-response compatibility effects. Neuropsychologia. 1988; 26 435-444
- 89 Verfaellie M, Heilman K M. Hemispheric asymmetries in attentional control: implications for hand preference in sensorimotor tasks. Brain Cogn. 1990; 14 70-80
- 90 Posner M I, Walker J A, Friedrich F J. et al . Effects of parietal injury on covert orienting of attention. J Neurosci. 1984; 4 1863-1874
- 91 Rushworth M F, Ellison A, Walsh V. Complementary localization and lateralization of orienting and motor attention. Nat Neurosci. 2001; 4 656-661
- 92 Rushworth M F, Nixon P D, Renowden S. et al . The left parietal cortex and motor attention. Neuropsychologia. 1997; 35 1261-1273
- 93 Castiello U, Paine M. Effects of left parietal injury on covert orienting of attention. J Neurol Neurosurg Psychiatr. 2002; 72 73-76
- 94 Rushworth M FS, Johansen-Berg H, Gobel S MG. et al . The left parietal and premotor cortices: motor attention and selection. NeuroImage. 2003; 20 89-100
- 95 Desmurget M, Epstein C M, Turner R S. et al . Role of the posterior parietal cortex in updating reaching movements to a visual target. Nat Neurosci. 1999; 2 563-567
-
96 Fink G R, Heide W.
Therapie des visuell räumlichen Neglect. In: Nelles G (Hrsg) Neurologische Rehabilitation. Stuttgart; Thieme 2004: 122-129
Univ.-Prof. Dr. med. Gereon R. Fink
Neurologische Klinik · Universitätsklinikum Aachen
52074 Aachen
eMail: gfink@ukaachen.de