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research
The affective modulation of motor awareness in anosognosia for hemiplegia : Behavioural and lesion evidence
Authors
Aikaterini Fotopoulou
Azevedo
+97 more
Babinski
Bates
Baumgartner
Berti
Berti
Besharati
Bisiach
Bisiach
Bradley
Burgess
Butler
Cocchini
Craig
Crawford
Crawford
Crawford
Critchley
Critchley
Cutting
Davidson
Davies
Dubois
Erthal
Feinberg
Folstein
Fotopoulou
Fotopoulou
Fotopoulou
Fotopoulou
Fotopoulou
Fotopoulou
Friston
Frost
Gainotti
Gallagher
Gentsch
Gerstmann
Geva
Goldstein
Gray
Graziano
Guan
Hajcak
Hartikainen
Heilman
Holmes
Isen
Jenkinson
Jenkinson
Kaplan-Solms
Kapur
Karnath
Karnath
Marcel
Mark Solms
Martin
McIntosh
Michael Kopelman
Mograbi
Moro
Nadrone
Nasreddine
Nummenmaa
O'Doherty
Oliveri
Orfei
Paul M. Jenkinson
Pereira
Phelps
Romano
Rorden
Rorden
Ross
Sahba Besharati
Seeley
Shallice
Starkstein
StataCorp
Stephanie J. Forkel
Tipples
Turnbull
Turnbull
Turnbull
Turnbull
Venneri
Vocat
Vocat
Volle
Vuilleumier
Vuilleumier
Wechsler
Wechsler
Weinstein
Weinstein
Weinstein
Wilson
Zigmond
Publication date
1 December 2014
Publisher
'Elsevier BV'
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on
PubMed
Abstract
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).The possible role of emotion in anosognosia for hemiplegia (i.e., denial of motor deficits contralateral to a brain lesion), has long been debated between psychodynamic and neurocognitive theories. However, there are only a handful of case studies focussing on this topic, and the precise role of emotion in anosognosia for hemiplegia requires empirical investigation. In the present study, we aimed to investigate how negative and positive emotions influence motor awareness in anosognosia. Positive and negative emotions were induced under carefully-controlled experimental conditions in right-hemisphere stroke patients with anosognosia for hemiplegia (n = 11) and controls with clinically normal awareness (n = 10). Only the negative, emotion induction condition resulted in a significant improvement of motor awareness in anosognosic patients compared to controls; the positive emotion induction did not. Using lesion overlay and voxel-based lesion-symptom mapping approaches, we also investigated the brain lesions associated with the diagnosis of anosognosia, as well as with performance on the experimental task. Anatomical areas that are commonly damaged in AHP included the right-hemisphere motor and sensory cortices, the inferior frontal cortex, and the insula. Additionally, the insula, putamen and anterior periventricular white matter were associated with less awareness change following the negative emotion induction. This study suggests that motor unawareness and the observed lack of negative emotions about one's disabilities cannot be adequately explained by either purely motivational or neurocognitive accounts. Instead, we propose an integrative account in which insular and striatal lesions result in weak interoceptive and motivational signals. These deficits lead to faulty inferences about the self, involving a difficulty to personalise new sensorimotor information, and an abnormal adherence to premorbid beliefs about the body.Peer reviewedFinal Published versio
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