Brain Imaging and Behavior

, Volume 11, Issue 1, pp 17–29 | Cite as

Evoking visual neglect-like deficits in healthy volunteers – an investigation by repetitive navigated transcranial magnetic stimulation

  • Katrin Giglhuber
  • Stefanie Maurer
  • Claus Zimmer
  • Bernhard Meyer
  • Sandro M. Krieg
Original Research


In clinical practice, repetitive navigated transcranial magnetic stimulation (rTMS) is of particular interest for non-invasive mapping of cortical language areas. Yet, rTMS studies try to detect further cortical functions. Damage to the underlying network of visuospatial attention function can result in visual neglect—a severe neurological deficit and influencing factor for a significantly reduced functional outcome. This investigation aims to evaluate the use of rTMS for evoking visual neglect in healthy volunteers and the potential of specifically locating cortical areas that can be assigned for the function of visuospatial attention. Ten healthy, right-handed subjects underwent rTMS visual neglect mapping. Repetitive trains of 5 Hz and 10 pulses were applied to 52 pre-defined cortical spots on each hemisphere; each cortical spot was stimulated 10 times. Visuospatial attention was tested time-locked to rTMS pulses by a landmark task. Task pictures were displayed tachistoscopically for 50 ms. The subjects’ performance was analyzed by video, and errors were referenced to cortical spots. We observed visual neglect-like deficits during the stimulation of both hemispheres. Errors were categorized into leftward, rightward, and no response errors. Rightward errors occurred significantly more often during stimulation of the right hemisphere than during stimulation of the left hemisphere (mean rightward error rate (ER) 1.6 ± 1.3 % vs. 1.0 ± 1.0 %, p = 0.0141). Within the left hemisphere, we observed predominantly leftward errors rather than rightward errors (mean leftward ER 2.0 ± 1.3 % vs. rightward ER 1.0 ± 1.0 %; p = 0.0005). Visual neglect can be elicited non-invasively by rTMS, and cortical areas eloquent for visuospatial attention can be detected. Yet, the correlation of this approach with clinical findings has to be shown in upcoming steps.


Cortical mapping Landmark task Neuropsychology Tachistoscopic testing Transcranial magnetic stimulation Visual neglect 



Diffusion tensor imaging


Error rate


Frontal eye field


Functional magnetic resonance imaging


Fiber tracking




Magnetic resonance imaging


Resting motor threshold


Navigated transcranial magnetic stimulation


Repetitive navigated transcranial magnetic stimulation


Transcranial magnetic stimulation


Temporoparietal junction


Standard deviation


Visual analogue scale





The first author gratefully acknowledges the support of the TUM graduate school.

Compliance with ethical standards

Conflict of interest

SK is a consultant for BrainLab AG (Feldkirchen, Germany). Yet, the study was completely financed by institutional grants from the Department of Neurosurgery and the Section of Neuroradiology, and all authors declare to have no conflict of interest affecting this study, nor the materials or methods used, nor the findings specified in this paper.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

Supplementary material

11682_2016_9506_MOESM1_ESM.docx (114 kb)
Online Resource 1 (DOCX 114 kb)
11682_2016_9506_MOESM2_ESM.docx (112 kb)
Online Resource 2 (DOCX 111 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.TUM-Neuroimaging Center, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  3. 3.Section of Neuroradiology, Department of Radiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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