Journal of Neurology

, Volume 256, Issue 5, pp 726–733 | Cite as

Eye-movement training-induced plasticity in patients with post-stroke hemianopia

  • Gereon Nelles
  • Anja Pscherer
  • Armin de Greiff
  • Michael Forsting
  • Horst Gerhard
  • Joachim Esser
  • H. Christoph Diener
Original Communication

Abstract

Substantial disability in patients with hemianopia results from reduced visual perception. Previous studies have shown that these patients have impaired saccades. Improving exploratory eye movements with appropriate training of saccades may help to partially compensate for the visuoperceptive impairment during daily life activities. The changes in cortical control of eye movements that may be induced by these training strategies, however, are not known. We used functional magnetic resonance imaging (fMRI) to study the training effects of eye-movement training on cortical control of saccades. Brain activation during visually guided saccades was measured in eight patients with an occipital cortical lesion causing homonymous hemianopia. Starting 8 weeks after the stroke, patients received 4 weeks of visual field training. The fMRI measurements were performed at baseline and after training. In five patients, follow-up fMRI was performed 4 weeks after the end of training. Differences in activation between rest and saccades as well as before and after training were assessed with statistical parametric mapping software (SPM’99). Twelve healthy subjects were scanned twice at a 4-week interval. In patients, significant activation at baseline was found in the frontal and parietal eye fields (FEF and PEF, respectively) bilaterally and in the supplementary eye field (SEF). Immediately after training, an area of increased activation was found in the left extrastriate cortex of the affected hemisphere. At follow-up, relatively more activation was found in the right peristriate cortex and in the SEF of the unaffected side. A relative decrease of activation was found in the left FEF. In this group of patients, eye-movement training induced altered brain activation in the striate and extrastriate cortex as well as in oculomotor areas.

Keywords

Eye movement Functional magnetic resonance imaging Hemianopia Rehabilitation Saccades Stroke Visual field deficit 

Abbreviations

ACPC

Anterior posterior commissural line

FEF

Frontal eye fields

PCA

Posterior cerebral artery

PEF

Parietal eye field

SEF

Supplementary eye fields

SPM

Statistical parametric mapping

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gereon Nelles
    • 1
    • 5
  • Anja Pscherer
    • 1
  • Armin de Greiff
    • 1
    • 2
  • Michael Forsting
    • 1
    • 2
  • Horst Gerhard
    • 3
  • Joachim Esser
    • 1
    • 4
  • H. Christoph Diener
    • 1
  1. 1.Neurologische Klinik und PoliklinikUniversitätsklinikum EssenEssenGermany
  2. 2.Institut für Diagnostische und Interventionelle Radiologie und NeuroradiologieUniversitätsklinikum EssenEssenGermany
  3. 3.Neurologische Klinik Philippusstift gGmbH EssenEssenGermany
  4. 4.Zentrum für Augenheilkunde, Abteilung für Erkrankungen des vorderen AugenabschnittesUniversitätsklinikum EssenEssenGermany
  5. 5.KölnGermany

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