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Unilateral Neglect

Unilateral neglect is a neurological deficit of utilization and consciousness of space, frequently occurring after right brain damage, in particular in case of parietal damage. Neglect is a multi-component syndrome, but its defining feature is that patients fail to voluntarily attend to, or to act in, the opposite (left) half of space or of the body. Polymorphism and complexity take also place in terms of physiopathological mechanisms, with possible combination of spatially lateralized processes (attention, representation) et non lateralized processes (attention, spatial working memory, remapping). This peculiar neurological disorder induces many functional debilitating effects on everyday life, and is responsible for poor functional recovery. It appears thus relevant to assess precisely this deficit and it underlines the importance of therapeutic stake. Many different therapeutic methods have been developed, initially based on intention and conscious effort ('top-down' approach). The more encouraging perspectives in terms of generalization and transfer are based on more automatic processes ('bottom-up') involving sensory or vestibular stimulations, or mediated by after-effects induced by prism adaptation. Some additional methods are more recently experimented, in particular involving psychopharmacological process and centering on management of non lateralized attentional deficits. In the more recent years, cerebral transcranial stimulation tedchniques have been used to test the theorical proposal that neglect occurs because a unilateral stroke disrupts the normal balance of neural activity between the two hemispheres. This kind of approach seems to be promising in terms of therapeutic possibilities.

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